Provider Demographics
NPI:1770988750
Name:WASHINGTON, SUZAN A (PHD)
Entity type:Individual
Prefix:DR
First Name:SUZAN
Middle Name:A
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 SANCTUARY DR APT 205B
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-7973
Mailing Address - Country:US
Mailing Address - Phone:847-245-8557
Mailing Address - Fax:
Practice Address - Street 1:849 SANCTUARY DR APT 205B
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-7973
Practice Address - Country:US
Practice Address - Phone:847-245-8557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health