Provider Demographics
NPI:1851179899
Name:SHUSETTE, RAQUEL LANE
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:LANE
Last Name:SHUSETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6949 BIRDSEYE AVE NE APT 111
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-4510
Mailing Address - Country:US
Mailing Address - Phone:805-861-6817
Mailing Address - Fax:
Practice Address - Street 1:522 W RIVERSIDE AVE STE 4691
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0580
Practice Address - Country:US
Practice Address - Phone:360-605-0163
Practice Address - Fax:855-959-2451
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA103K00000X, 106E00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst