Provider Demographics
NPI:1306205984
Name:DOWELL, SUSAN ANNE
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANNE
Last Name:DOWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:ANN
Other - Last Name:DOWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADC II
Mailing Address - Street 1:PO BOX 1121
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-0254
Mailing Address - Country:US
Mailing Address - Phone:541-492-0175
Mailing Address - Fax:541-677-7199
Practice Address - Street 1:548 SE JACKSON STREET
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-0254
Practice Address - Country:US
Practice Address - Phone:541-492-0175
Practice Address - Fax:541-677-7199
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10-06-53101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)