Provider Demographics
NPI:1477863447
Name:UNDERBRINK, SUSAN K (SLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:UNDERBRINK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8642 FAUNTLEROY PL SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-2412
Mailing Address - Country:US
Mailing Address - Phone:206-850-6472
Mailing Address - Fax:
Practice Address - Street 1:516 23RD AVE SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4659
Practice Address - Country:US
Practice Address - Phone:253-845-6631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASI60183715235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist