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General NPI Number Information
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NPI Number | 1619094570
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Entity Type | Individual
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Provider Name | SUSAN WYNN HORTON PHD
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Gender | Female
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Dates
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Enumeration Date | 03/24/2007
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Last Update Date | 11/01/2013
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Provider Practice Location Address
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Address Line | 237 NE CHKALOV DR SUITE 110
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City | VANCOUVER
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State | WA
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Zip | 98684-5054
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Country | US
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Telephone | 360-921-0745
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Fax | 360-260-9777
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Provider Business Mailing Address
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Address Line | 237 NE CHKALOV DR SUITE 110
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City | VANCOUVER
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State | WA
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Zip | 98684-5054
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Country | US
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Telephone | 360-921-0745
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Fax | 360-260-9777
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0274
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY1226
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License Number State | WA
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