Provider Demographics
NPI:1104048958
Name:SUSAN TOTH PATIEJUNAS, PH.D., LLC
Entity type:Organization
Organization Name:SUSAN TOTH PATIEJUNAS, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:KATALIN
Authorized Official - Last Name:TOTH PATIEJUNAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:425-241-5531
Mailing Address - Street 1:1700 NW GILMAN BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5349
Mailing Address - Country:US
Mailing Address - Phone:425-241-5531
Mailing Address - Fax:425-427-2477
Practice Address - Street 1:1700 NW GILMAN BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5349
Practice Address - Country:US
Practice Address - Phone:425-241-5531
Practice Address - Fax:425-427-2477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002368103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty