Provider Demographics
NPI:1891814349
Name:VANN, MARY SUSAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:SUSAN
Last Name:VANN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 JADWIN AVE STE E
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4241
Mailing Address - Country:US
Mailing Address - Phone:509-528-4574
Mailing Address - Fax:
Practice Address - Street 1:660 JADWIN AVE STE E
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4241
Practice Address - Country:US
Practice Address - Phone:509-528-4574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3564103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical