Provider Demographics
NPI:1487009726
Name:SUSAN K. LEEDS, LLC
Entity Type:Organization
Organization Name:SUSAN K. LEEDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEEDS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:425-454-2835
Mailing Address - Street 1:1300 114TH AVE SE STE 102
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6928
Mailing Address - Country:US
Mailing Address - Phone:425-454-2835
Mailing Address - Fax:425-454-2315
Practice Address - Street 1:1300 114TH AVE SE STE 102
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6928
Practice Address - Country:US
Practice Address - Phone:425-454-2835
Practice Address - Fax:425-454-2315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-24
Last Update Date:2017-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000042371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty