Provider Demographics
NPI:1083825806
Name:WICHERT, SUSANNE MARIA (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:MARIA
Last Name:WICHERT
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14436 88TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-5100
Mailing Address - Country:US
Mailing Address - Phone:425-821-9208
Mailing Address - Fax:
Practice Address - Street 1:125 E MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1543
Practice Address - Country:US
Practice Address - Phone:360-794-1951
Practice Address - Fax:360-794-6711
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003989101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health