Healthcare Provider Details

I. General information

NPI: 1932843422
Provider Name (Legal Business Name): SUSAN POOLE, PHD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3213 N 31ST ST
TACOMA WA
98407-5901
US

IV. Provider business mailing address

3213 N 31ST ST
TACOMA WA
98407-5901
US

V. Phone/Fax

Practice location:
  • Phone: 253-254-5232
  • Fax:
Mailing address:
  • Phone: 253-254-5232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. SUSAN JANETTE POOLE
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 253-254-5232