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General NPI Number Information
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NPI Number | 1336691906
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Entity Type | Individual
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Provider Name | SUZANNE DEWALT
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Gender | Female
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Dates
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Enumeration Date | 10/31/2016
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 840 N AVENUE 66
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City | LOS ANGELES
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State | CA
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Zip | 90042-1508
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Country | US
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Telephone | 626-395-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 623 N PARISH PL
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City | BURBANK
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State | CA
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Zip | 91506-1701
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Country | US
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Telephone | 818-450-9614
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 142595
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 156827
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 148381
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License Number State | CA
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