Provider Demographics
NPI:1588710883
Name:ROBISON, SUSANNE (LMP)
Entity type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:
Last Name:ROBISON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 73RD ST SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-3347
Mailing Address - Country:US
Mailing Address - Phone:253-565-7567
Mailing Address - Fax:253-589-8472
Practice Address - Street 1:5005 CENTER ST
Practice Address - Street 2:SUITE I
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-2347
Practice Address - Country:US
Practice Address - Phone:253-565-7567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016261174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist