Provider Demographics
NPI:1710101431
Name:GRAY, SUZANNE LOUISE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:LOUISE
Last Name:GRAY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:LOUISE
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:10509 108TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98498-1502
Mailing Address - Country:US
Mailing Address - Phone:253-582-8780
Mailing Address - Fax:
Practice Address - Street 1:10509 108TH AVE SW
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98498-1502
Practice Address - Country:US
Practice Address - Phone:253-582-8780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018329174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist