Provider Demographics
NPI:1295057206
Name:WILSON, SUZAN ROOD (LMFT)
Entity type:Individual
Prefix:MS
First Name:SUZAN
Middle Name:ROOD
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 46TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-2416
Mailing Address - Country:US
Mailing Address - Phone:206-935-4744
Mailing Address - Fax:206-937-1516
Practice Address - Street 1:2331 46TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-2416
Practice Address - Country:US
Practice Address - Phone:206-935-4744
Practice Address - Fax:206-937-1516
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
102L00000X
WALF00001297106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst