Healthcare Provider Details

I. General information

NPI: 1013965169
Provider Name (Legal Business Name): SUSAN MAUREEN MCCARTHY LAC, LLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E 24TH ST
VANCOUVER WA
98663-3214
US

IV. Provider business mailing address

300 E 24TH ST
VANCOUVER WA
98663-3214
US

V. Phone/Fax

Practice location:
  • Phone: 360-798-7625
  • Fax: 360-529-0691
Mailing address:
  • Phone: 360-798-7625
  • Fax: 360-529-0691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC2007
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: