Provider Demographics
NPI:1053479048
Name:VON SUHR, JOLIE CHRISTINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOLIE
Middle Name:CHRISTINE
Last Name:VON SUHR
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 1:9601 STEILACOOM BLVD SW
Mailing Address - Street 2:WESTERN STATE HOSPITAL
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98498-7213
Mailing Address - Country:US
Mailing Address - Phone:253-761-7541
Mailing Address - Fax:
Practice Address - Street 1:9601 STEILACOOM BLVD SW
Practice Address - Street 2:WESTERN STATE HOSPITAL
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98498-7213
Practice Address - Country:US
Practice Address - Phone:253-761-7541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003431103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA20005200OtherEMPLOYEE ID NUMBER