Provider Demographics
NPI:1396090437
Name:WILLIAMS, SUZANNE (PSYD)
Entity type:Individual
Prefix:MISS
First Name:SUZANNE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:6210 SW POMONA ST APT 31
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-6786
Mailing Address - Country:US
Mailing Address - Phone:039-097-7663
Mailing Address - Fax:
Practice Address - Street 1:2600 CENTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2669
Practice Address - Country:US
Practice Address - Phone:503-572-6070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-15
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health