Provider Demographics
NPI:1891196564
Name:HENDERSHOT LINK, SUSAN CHRISTINE (RN, PHD, PMHCNS-BC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:CHRISTINE
Last Name:HENDERSHOT LINK
Suffix:
Gender:F
Credentials:RN, PHD, PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 NE 131ST CIR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-3164
Mailing Address - Country:US
Mailing Address - Phone:360-931-7570
Mailing Address - Fax:
Practice Address - Street 1:1312 NE 131ST CIR
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-3164
Practice Address - Country:US
Practice Address - Phone:360-931-7570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200470005CNS364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP26758Medicare UPIN