Provider Demographics
NPI:1346233137
Name:ADAMS, SUSAN M (LMP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:32506 NEWCASTLE DR
Mailing Address - Street 2:
Mailing Address - City:BLACK DIAMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98010-9720
Mailing Address - Country:US
Mailing Address - Phone:253-332-2578
Mailing Address - Fax:
Practice Address - Street 1:603 HUNT AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-1117
Practice Address - Country:US
Practice Address - Phone:253-332-2578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009290225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7824ADOtherREGENCE B/S
WA8930867OtherCRIME VICTIMS
WA183081OtherDEPT OF L&I