Provider Demographics
NPI:1649581901
Name:MCCANN, SUZANNE GARNET (MSW)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:GARNET
Last Name:MCCANN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:SUZANNE
Other - Middle Name:GARNET
Other - Last Name:GODSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3415 SE POWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3371
Mailing Address - Country:US
Mailing Address - Phone:503-205-3541
Mailing Address - Fax:503-205-0188
Practice Address - Street 1:3415 SE POWELL BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3371
Practice Address - Country:US
Practice Address - Phone:503-205-3541
Practice Address - Fax:503-205-0188
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health