Provider Demographics
NPI:1164433769
Name:HUCK, SUSAN M (MA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:HUCK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S UNION AVE
Mailing Address - Street 2:SUITE 5006
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1702
Mailing Address - Country:US
Mailing Address - Phone:253-627-1454
Mailing Address - Fax:253-572-8712
Practice Address - Street 1:1901 S UNION AVE
Practice Address - Street 2:SUITE 5006
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1702
Practice Address - Country:US
Practice Address - Phone:253-627-1454
Practice Address - Fax:253-572-8712
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001133106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA-02705OtherWA STATE DEPT OF HEALTH
LF00001133OtherWA STATE DEPT OF HEALTH