Provider Demographics
NPI:1316339617
Name:COUCH, SUSAN
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:COUCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 HIGH ST SE
Mailing Address - Street 2:SUITE #218
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3660
Mailing Address - Country:US
Mailing Address - Phone:503-400-5289
Mailing Address - Fax:
Practice Address - Street 1:161 HIGH ST SE
Practice Address - Street 2:SUITE #218
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3660
Practice Address - Country:US
Practice Address - Phone:503-400-5289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist