Provider Demographics
NPI:1013046598
Name:TAYLOR, SUZANNE LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:LEE
Last Name:TAYLOR
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 1:1977 CASCADE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CAMANO ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98282-8437
Mailing Address - Country:US
Mailing Address - Phone:425-418-1680
Mailing Address - Fax:
Practice Address - Street 1:1977 CASCADE VIEW DR
Practice Address - Street 2:
Practice Address - City:CAMANO ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98282-8437
Practice Address - Country:US
Practice Address - Phone:425-418-1680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1175103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91-2140849OtherSERVICE CORPORATION