Provider Demographics
NPI:1629307939
Name:MCDONOUGH, SUZANNE ANNETTE (LMP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:ANNETTE
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 CALIFORNIA AVE SW
Mailing Address - Street 2:SUITE F
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-1501
Mailing Address - Country:US
Mailing Address - Phone:206-937-8866
Mailing Address - Fax:206-937-8869
Practice Address - Street 1:5400 CALIFORNIA AVE SW
Practice Address - Street 2:SUITE F
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1501
Practice Address - Country:US
Practice Address - Phone:206-937-8866
Practice Address - Fax:206-937-8869
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020985174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist