Provider Demographics
NPI:1558571471
Name:CARLSON, SUE (SUENEELL)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:SUENEELL
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:NEELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:619 N 35TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8642
Mailing Address - Country:US
Mailing Address - Phone:206-285-0412
Mailing Address - Fax:
Practice Address - Street 1:619 N 35TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8642
Practice Address - Country:US
Practice Address - Phone:206-285-0412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003624101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health