Provider Demographics
NPI:1851692487
Name:HOOVER, SUZANNE Z (LICSW, CEAP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:Z
Last Name:HOOVER
Suffix:
Gender:F
Credentials:LICSW, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3876 BRIDGE WAY N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7951
Mailing Address - Country:US
Mailing Address - Phone:206-661-0769
Mailing Address - Fax:
Practice Address - Street 1:3876 BRIDGE WAY N
Practice Address - Street 2:SUITE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7951
Practice Address - Country:US
Practice Address - Phone:206-661-0769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 000062151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA602090775OtherUNIFIED BUSINESS ID
WALW 00006215OtherSOCIAL WORKER INDEPENDENT CLINICAL LICENSE