Provider Demographics
NPI:1629452370
Name:HIGHT, SUSAN G
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:HIGHT
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 1:2645 PORTLAND RD NE STE 120
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-0200
Mailing Address - Country:US
Mailing Address - Phone:425-956-4086
Mailing Address - Fax:425-491-7257
Practice Address - Street 1:2645 PORTLAND RD NE STE 120
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-0200
Practice Address - Country:US
Practice Address - Phone:425-956-4086
Practice Address - Fax:425-491-7257
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
OR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst