Provider Demographics
NPI:1831309293
Name:PONSIOEN, SUZANNE M (LMFT)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:M
Last Name:PONSIOEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2826
Mailing Address - Country:US
Mailing Address - Phone:541-653-2958
Mailing Address - Fax:541-610-1760
Practice Address - Street 1:328 W BROADWAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2826
Practice Address - Country:US
Practice Address - Phone:541-653-2958
Practice Address - Fax:541-610-1760
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0783106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty