Provider Demographics
NPI:1770667206
Name:IVEY, SUZANNE BACHMAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:BACHMAN
Last Name:IVEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:785 ERICKSEN AVE NE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1875
Mailing Address - Country:US
Mailing Address - Phone:206-842-9949
Mailing Address - Fax:360-697-1079
Practice Address - Street 1:785 ERICKSEN AVE NE
Practice Address - Street 2:SUITE 117
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1875
Practice Address - Country:US
Practice Address - Phone:206-842-9949
Practice Address - Fax:360-697-1079
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPSY0001604103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical