Provider Demographics
NPI:1063932515
Name:BOEGE, SUSAN M (CDPT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:BOEGE
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 87TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-3673
Mailing Address - Country:US
Mailing Address - Phone:425-327-9128
Mailing Address - Fax:
Practice Address - Street 1:4232 198TH ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6747
Practice Address - Country:US
Practice Address - Phone:425-248-4900
Practice Address - Fax:425-248-4703
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60750249101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)