Provider Demographics
NPI:1740487818
Name:MAGNUSON, SULFIATI (MA, LMHC)
Entity type:Individual
Prefix:MS
First Name:SULFIATI
Middle Name:
Last Name:MAGNUSON
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11416 SLATER AVE NE
Mailing Address - Street 2:SUITE 202-A
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-8827
Mailing Address - Country:US
Mailing Address - Phone:425-893-8969
Mailing Address - Fax:
Practice Address - Street 1:11416 SLATER AVE NE
Practice Address - Street 2:SUITE 202-A
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-8827
Practice Address - Country:US
Practice Address - Phone:425-893-8969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003589101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health