Provider Demographics
NPI:1346329745
Name:CHILDERS, SUSAN E (PHD, LICSW)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:PHD, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 SUNSET AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-1644
Mailing Address - Country:US
Mailing Address - Phone:206-382-7359
Mailing Address - Fax:206-938-8232
Practice Address - Street 1:1317 SUNSET AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-1644
Practice Address - Country:US
Practice Address - Phone:206-382-7359
Practice Address - Fax:206-938-8232
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000053501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical