Provider Demographics
NPI:1457424368
Name:SCHLOSSER, SUSAN A (LMP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:A
Last Name:SCHLOSSER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14310 LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-1700
Mailing Address - Country:US
Mailing Address - Phone:425-778-6561
Mailing Address - Fax:425-743-3117
Practice Address - Street 1:22002 64TH AVE W
Practice Address - Street 2:SUITE 12
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2528
Practice Address - Country:US
Practice Address - Phone:425-778-6561
Practice Address - Fax:425-743-3117
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4682225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5742SCOtherREGENCE BLUE SHIELD
5064500OtherAETNA INSURANCE