Healthcare Provider Details

I. General information

NPI: 1891196564
Provider Name (Legal Business Name): SUSAN CHRISTINE HENDERSHOT LINK RN, PH.D., PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 NE 131ST CIR
VANCOUVER WA
98685-3164
US

IV. Provider business mailing address

1312 NE 131ST CIR
VANCOUVER WA
98685-3164
US

V. Phone/Fax

Practice location:
  • Phone: 360-931-7570
  • Fax:
Mailing address:
  • Phone: 360-931-7570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number200470005CNS
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: