Provider Demographics
NPI:1457620072
Name:ST LOUIS, SUZE (LMP)
Entity Type:Individual
Prefix:
First Name:SUZE
Middle Name:
Last Name:ST LOUIS
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 1:5525 COLLEGE GLEN LOOP SE APT C104
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5111
Mailing Address - Country:US
Mailing Address - Phone:360-556-7758
Mailing Address - Fax:
Practice Address - Street 1:10700 SE 208TH ST STE 207
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-5545
Practice Address - Country:US
Practice Address - Phone:253-854-3185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60237202225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist