Provider Demographics
NPI:1710021050
Name:WOZNIAK, SUSAN BETH (LMP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:BETH
Last Name:WOZNIAK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:GOLDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7701 23RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-4318
Mailing Address - Country:US
Mailing Address - Phone:206-898-2342
Mailing Address - Fax:
Practice Address - Street 1:7701 23RD AVE NW
Practice Address - Street 2:4511 WALLINGFORD AVE N
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-4318
Practice Address - Country:US
Practice Address - Phone:206-782-1805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009649225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist