Provider Demographics
NPI:1598978637
Name:SUTHER, KONNIE S (LAC)
Entity type:Individual
Prefix:
First Name:KONNIE
Middle Name:S
Last Name:SUTHER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 NE 41ST ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5428
Mailing Address - Country:US
Mailing Address - Phone:206-218-7440
Mailing Address - Fax:206-342-3825
Practice Address - Street 1:4000 NE 41ST ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5428
Practice Address - Country:US
Practice Address - Phone:206-218-7440
Practice Address - Fax:206-342-3825
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2690171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist