Provider Demographics
NPI:1982846432
Name:GADAU, SUSAN P (RD, CD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:P
Last Name:GADAU
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 112TH AVE NE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4500
Mailing Address - Country:US
Mailing Address - Phone:425-688-5437
Mailing Address - Fax:425-688-5710
Practice Address - Street 1:1120 112TH AVE NE
Practice Address - Street 2:SUITE 150
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4500
Practice Address - Country:US
Practice Address - Phone:425-688-5437
Practice Address - Fax:425-688-5710
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 00000179133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADI 00000179OtherWASHINGTON STATE DOH CERTIFICATION