Healthcare Provider Details

I. General information

NPI: 1295057206
Provider Name (Legal Business Name): SUZAN ROOD WILSON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 46TH AVE SW
SEATTLE WA
98116-2416
US

IV. Provider business mailing address

2331 46TH AVE SW
SEATTLE WA
98116-2416
US

V. Phone/Fax

Practice location:
  • Phone: 206-935-4744
  • Fax: 206-937-1516
Mailing address:
  • Phone: 206-935-4744
  • Fax: 206-937-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF00001297
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: