Provider Demographics
NPI:1073655031
Name:THOMSON, SUZANNE LYNN (LM, CPM)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:LYNN
Last Name:THOMSON
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10357 14TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-5303
Mailing Address - Country:US
Mailing Address - Phone:206-365-5156
Mailing Address - Fax:206-362-5344
Practice Address - Street 1:10357 14TH AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98177-5303
Practice Address - Country:US
Practice Address - Phone:206-365-5156
Practice Address - Fax:206-362-5344
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW00000204176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7084155Medicaid