Provider Demographics
NPI:1215287586
Name:DICKINSON, SUZAN MARIE (MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:SUZAN
Middle Name:MARIE
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:MS
Other - First Name:SUE
Other - Middle Name:MARIE
Other - Last Name:DICKINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:17201 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:WA
Mailing Address - Zip Code:98826-9134
Mailing Address - Country:US
Mailing Address - Phone:509-679-9157
Mailing Address - Fax:509-667-2339
Practice Address - Street 1:17201 N SHORE DR
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:WA
Practice Address - Zip Code:98826-9134
Practice Address - Country:US
Practice Address - Phone:509-679-9157
Practice Address - Fax:509-667-2339
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF 00001023106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist