Provider Demographics
NPI:1013211648
Name:HAWKINS, SUSAN A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:A
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 LAKESIDE AVE STE A-61
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-6551
Mailing Address - Country:US
Mailing Address - Phone:206-455-8972
Mailing Address - Fax:877-418-7475
Practice Address - Street 1:140 LAKESIDE AVE STE A-61
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-6551
Practice Address - Country:US
Practice Address - Phone:206-455-8972
Practice Address - Fax:877-418-7475
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002717103TC0700X, 103TC1900X, 103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent