Provider Demographics
NPI:1124569611
Name:GRUBB, SUSAN ANN-WESTOVER (MSW, LICSWA, GMHP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN-WESTOVER
Last Name:GRUBB
Suffix:
Gender:F
Credentials:MSW, LICSWA, GMHP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ANN
Other - Last Name:WESTOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSWA,GMHP
Mailing Address - Street 1:PO BOX 2569
Mailing Address - Street 2:SUNRISE SERVICES INC
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98213
Mailing Address - Country:US
Mailing Address - Phone:425-212-4200
Mailing Address - Fax:425-212-4201
Practice Address - Street 1:2326 RUCKER AVE # 303
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2723
Practice Address - Country:US
Practice Address - Phone:425-789-9587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC60656968101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor