Provider Demographics
NPI:1720396286
Name:PATTON, SUSANNA DOROTHY (BS)
Entity type:Individual
Prefix:MS
First Name:SUSANNA
Middle Name:DOROTHY
Last Name:PATTON
Suffix:
Gender:
Credentials:BS
Other - Prefix:MRS
Other - First Name:SUSANNA
Other - Middle Name:DOROTHY
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1498 SE TECH CENTER PL STE 300
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-5509
Mailing Address - Country:US
Mailing Address - Phone:360-567-2200
Mailing Address - Fax:360-567-2212
Practice Address - Street 1:1498 SE TECH CENTER PL STE 300
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-5509
Practice Address - Country:US
Practice Address - Phone:360-984-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61201631101Y00000X
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor