Provider Demographics
NPI:1902042682
Name:HOVDA, SUSAN KAY I (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KAY
Last Name:HOVDA
Suffix:I
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 116
Mailing Address - Street 2:
Mailing Address - City:SOUTH CLEELUM
Mailing Address - State:WA
Mailing Address - Zip Code:98943
Mailing Address - Country:US
Mailing Address - Phone:509-674-2822
Mailing Address - Fax:
Practice Address - Street 1:112 RAIL ROAD STREET
Practice Address - Street 2:
Practice Address - City:CLEELUM
Practice Address - State:WA
Practice Address - Zip Code:98922
Practice Address - Country:US
Practice Address - Phone:509-674-2822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
173C00000X
WAMA00015713173C00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist