Provider Demographics
NPI:1689141095
Name:HATTEN, SUSAN NORA
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:NORA
Last Name:HATTEN
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:PO BOX 152
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99122-0152
Mailing Address - Country:US
Mailing Address - Phone:509-725-2111
Mailing Address - Fax:509-725-2141
Practice Address - Street 1:505 1ST ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:WA
Practice Address - Zip Code:99122-0152
Practice Address - Country:US
Practice Address - Phone:509-725-2111
Practice Address - Fax:509-725-2141
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60026482101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)