Provider Demographics
NPI:1407683519
Name:PERNA, SUE ANN
Entity type:Individual
Prefix:
First Name:SUE ANN
Middle Name:
Last Name:PERNA
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 1:2655 S RED RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-9150
Mailing Address - Country:US
Mailing Address - Phone:360-763-3646
Mailing Address - Fax:
Practice Address - Street 1:2655 S RED RIVER RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9150
Practice Address - Country:US
Practice Address - Phone:360-763-3646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-14
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician