Provider Demographics
NPI:1437585304
Name:DOAN, SUZANNA BROOKE (LMP)
Entity Type:Individual
Prefix:
First Name:SUZANNA
Middle Name:BROOKE
Last Name:DOAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10107 E 8TH AVE
Mailing Address - Street 2:APT #21
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-6933
Mailing Address - Country:US
Mailing Address - Phone:509-891-7365
Mailing Address - Fax:
Practice Address - Street 1:124 E ROWAN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1214
Practice Address - Country:US
Practice Address - Phone:509-487-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60405943225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist