Provider Demographics
NPI:1558468355
Name:VRTIS-YOUNGER, SUSAN MARIE (LCSW, ACSW, CART)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:VRTIS-YOUNGER
Suffix:
Gender:F
Credentials:LCSW, ACSW, CART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 LIGGET AVENUE
Mailing Address - Street 2:PMB 428, PO BOX 331400
Mailing Address - City:JBLM
Mailing Address - State:WA
Mailing Address - Zip Code:98433-0900
Mailing Address - Country:US
Mailing Address - Phone:210-982-5549
Mailing Address - Fax:
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVENUE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-2011
Practice Address - Country:US
Practice Address - Phone:253-968-2252
Practice Address - Fax:253-968-3278
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX535771041C0700X
ORL71701041C0700X
IN34005015A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100107920Medicaid