Healthcare Provider Details

I. General information

NPI: 1962905109
Provider Name (Legal Business Name): SUSANNA J SAXON AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-1349
US

IV. Provider business mailing address

11826 RESERVOIR RD E
PUYALLUP WA
98374-4617
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-0927
  • Fax:
Mailing address:
  • Phone: 253-426-9264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number61391726
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number81018
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number80686
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: