Provider Demographics
NPI:1518622893
Name:CLOUDY, SUSAN MELAINE (RDHEP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MELAINE
Last Name:CLOUDY
Suffix:
Gender:F
Credentials:RDHEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-1703
Mailing Address - Country:US
Mailing Address - Phone:503-769-9699
Mailing Address - Fax:
Practice Address - Street 1:521 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-1703
Practice Address - Country:US
Practice Address - Phone:503-769-9699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4032124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist