Provider Demographics
NPI:1609178003
Name:MONACO, SUSAN CATHERINE (LAC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CATHERINE
Last Name:MONACO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 KENYON ST NW
Mailing Address - Street 2:STE 9
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4553
Mailing Address - Country:US
Mailing Address - Phone:360-943-5570
Mailing Address - Fax:360-200-6627
Practice Address - Street 1:222 KENYON ST NW
Practice Address - Street 2:STE 9
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4553
Practice Address - Country:US
Practice Address - Phone:360-943-5570
Practice Address - Fax:360-200-6627
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60014641171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist