Provider Demographics
NPI:1316026263
Name:SUSAN B. PALMER-ANSORG, PH.D. PLLC
Entity Type:Organization
Organization Name:SUSAN B. PALMER-ANSORG, PH.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:PALMER-ANSORG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:425-357-8023
Mailing Address - Street 1:16000 BOTHELL EVERETT HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1742
Mailing Address - Country:US
Mailing Address - Phone:425-357-8023
Mailing Address - Fax:
Practice Address - Street 1:16000 BOTHELL EVERETT HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1742
Practice Address - Country:US
Practice Address - Phone:425-357-8023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA2532103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty