Provider Demographics
NPI:1477814804
Name:CHASSE, SUSAN (MA 60282097)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:CHASSE
Suffix:
Gender:F
Credentials:MA 60282097
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32405 MCKAY LN
Mailing Address - Street 2:
Mailing Address - City:BLACK DIAMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98010-9727
Mailing Address - Country:US
Mailing Address - Phone:206-383-6977
Mailing Address - Fax:
Practice Address - Street 1:670 NW GILMAN BLVD STE B2
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2444
Practice Address - Country:US
Practice Address - Phone:425-427-6562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60282097225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist