Provider Demographics
NPI:1992820500
Name:SPORL, SUSAN H (MSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:H
Last Name:SPORL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1546
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-3546
Mailing Address - Country:US
Mailing Address - Phone:253-851-9018
Mailing Address - Fax:253-851-3461
Practice Address - Street 1:3019 JUDSON ST
Practice Address - Street 2:SUITE C
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-5143
Practice Address - Country:US
Practice Address - Phone:253-851-9018
Practice Address - Fax:253-851-3461
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000061111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical