Provider Demographics
NPI:1851707046
Name:HERR, SUSAN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:HERR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 PIONEER DR APT P
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-8714
Mailing Address - Country:US
Mailing Address - Phone:503-871-7287
Mailing Address - Fax:
Practice Address - Street 1:3000 MARKET ST NE STE 355
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1892
Practice Address - Country:US
Practice Address - Phone:503-871-7287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19587225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist