Provider Demographics
NPI:1174058473
Name:SUSAN FRIEDRICH
Entity type:Organization
Organization Name:SUSAN FRIEDRICH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORIENTAL MEDICINE, ACUPUNCTURE
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:EAMP, AP, DOM
Authorized Official - Phone:425-405-0578
Mailing Address - Street 1:914 164TH ST SE # 183
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6385
Mailing Address - Country:US
Mailing Address - Phone:425-405-0578
Mailing Address - Fax:425-337-3945
Practice Address - Street 1:914 164TH ST SE # 183
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-6385
Practice Address - Country:US
Practice Address - Phone:425-405-0578
Practice Address - Fax:425-337-3945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60023290171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty