Healthcare Provider Details

I. General information

NPI: 1962955450
Provider Name (Legal Business Name): SUZANNE OELKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 08/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 MERIDIAN AVE N STE G11
SEATTLE WA
98133-9008
US

IV. Provider business mailing address

10700 MERIDIAN AVE N STE G11
SEATTLE WA
98133-9008
US

V. Phone/Fax

Practice location:
  • Phone: 206-366-3037
  • Fax: 206-461-6939
Mailing address:
  • Phone: 206-366-3037
  • Fax: 206-461-6939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number60344087
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: