Provider Demographics
NPI:1639937329
Name:JAMISON, SUZANNA ROSE (LISCWA)
Entity Type:Individual
Prefix:
First Name:SUZANNA
Middle Name:ROSE
Last Name:JAMISON
Suffix:
Gender:F
Credentials:LISCWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8304 NE 136TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-3376
Mailing Address - Country:US
Mailing Address - Phone:360-771-9099
Mailing Address - Fax:
Practice Address - Street 1:8304 NE 136TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-3376
Practice Address - Country:US
Practice Address - Phone:360-771-9099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASX614031221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty