Provider Demographics
NPI:1679658496
Name:TOTH PATIEJUNAS, SUSAN KATALIN (PHD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KATALIN
Last Name:TOTH PATIEJUNAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 NW GILMAN BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5349
Mailing Address - Country:US
Mailing Address - Phone:425-241-5531
Mailing Address - Fax:425-427-2477
Practice Address - Street 1:1700 NW GILMAN BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5349
Practice Address - Country:US
Practice Address - Phone:425-241-5531
Practice Address - Fax:425-427-2477
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002368103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
227550OtherINTERNAL ID-MOTOR VEHICLE ID
WA8323859Medicaid
WA8323859Medicaid
P73546Medicare UPIN