Healthcare Provider Details

I. General information

NPI: 1427532811
Provider Name (Legal Business Name): SUSAN PEACEY CDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9045 16TH AVE SW
SEATTLE WA
98106-2355
US

IV. Provider business mailing address

7001 SEAVIEW AVE NW # 160-717
SEATTLE WA
98117-6006
US

V. Phone/Fax

Practice location:
  • Phone: 206-762-7207
  • Fax:
Mailing address:
  • Phone: 206-919-7832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP00003967
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: