Provider Demographics
NPI:1912038621
Name:WENNER, SUZANNE (LAC, LMP)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:WENNER
Suffix:
Gender:F
Credentials:LAC, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 BETHEL ST NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-3306
Mailing Address - Country:US
Mailing Address - Phone:360-402-4675
Mailing Address - Fax:
Practice Address - Street 1:524 JEFFERSON ST SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1466
Practice Address - Country:US
Practice Address - Phone:360-402-4675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2190171100000X
WAMA11394174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered174400000XOther Service ProvidersSpecialist