Provider Demographics
NPI:1558720185
Name:SALE, SUSAN ELLEN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELLEN
Last Name:SALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 HOKU PUHIPAKA ST
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-4528
Mailing Address - Country:US
Mailing Address - Phone:360-798-6969
Mailing Address - Fax:
Practice Address - Street 1:270 WAIEHU BEACH RD
Practice Address - Street 2:SUITE 214
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1472
Practice Address - Country:US
Practice Address - Phone:808-242-7294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst