Provider Demographics
NPI:1427041805
Name:BAILY, SUZANNE (RD, CD)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:BAILY
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8552 18TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3644
Mailing Address - Country:US
Mailing Address - Phone:206-962-1010
Mailing Address - Fax:253-872-3448
Practice Address - Street 1:6852 S 220TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-1963
Practice Address - Country:US
Practice Address - Phone:253-872-3460
Practice Address - Fax:253-872-3448
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001873133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered