Provider Demographics
NPI:1356235287
Name:CEJA, SUSIE
Entity type:Individual
Prefix:
First Name:SUSIE
Middle Name:
Last Name:CEJA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-0151
Mailing Address - Country:US
Mailing Address - Phone:509-865-5121
Mailing Address - Fax:509-984-3793
Practice Address - Street 1:511 S ELM ST
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948-1651
Practice Address - Country:US
Practice Address - Phone:509-865-5121
Practice Address - Fax:509-984-3693
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1366634552Medicaid