Provider Demographics
NPI:1578784476
Name:ANSON, SUZAN A (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZAN
Middle Name:A
Last Name:ANSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13607 FIELDING RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-2424
Mailing Address - Country:US
Mailing Address - Phone:503-534-2747
Mailing Address - Fax:
Practice Address - Street 1:1815 NW FLANDERS ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2060
Practice Address - Country:US
Practice Address - Phone:503-534-2747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1472103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical