Provider Demographics
NPI:1316093370
Name:THODE, SUSAN M (M ED)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:THODE
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39626 224TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-8921
Mailing Address - Country:US
Mailing Address - Phone:360-825-0156
Mailing Address - Fax:
Practice Address - Street 1:1316 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2217
Practice Address - Country:US
Practice Address - Phone:253-839-1697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health