Provider Demographics
NPI:1659553725
Name:RODRIGUEZ, SUZANNE L (LICSW)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:L
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 S 2ND ST STE 710
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-2629
Mailing Address - Country:US
Mailing Address - Phone:509-480-1059
Mailing Address - Fax:509-452-2409
Practice Address - Street 1:6 S 2ND ST STE 710
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2629
Practice Address - Country:US
Practice Address - Phone:509-480-1059
Practice Address - Fax:509-452-2409
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 601373811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8900522Medicare PIN