Provider Demographics
NPI:1821188640
Name:ASHLEY, SUSAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:L
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1431 N LIBERTY LAKE RD STE B
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-8522
Mailing Address - Country:US
Mailing Address - Phone:509-928-6700
Mailing Address - Fax:509-928-0861
Practice Address - Street 1:1431 N LIBERTY LAKE RD STE B
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-8522
Practice Address - Country:US
Practice Address - Phone:509-928-6700
Practice Address - Fax:509-928-0861
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-14409207Q00000X
WAMD00028821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8139594Medicaid
WA8556240Medicare ID - Type Unspecified
WA8139594Medicaid