Provider Demographics
NPI:1801618152
Name:MOORE, SUSAN MARIE (CCSH, RPSGT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:CCSH, RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4029 MORGAN RD
Mailing Address - Street 2:
Mailing Address - City:SUMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98295-8804
Mailing Address - Country:US
Mailing Address - Phone:716-870-5591
Mailing Address - Fax:
Practice Address - Street 1:2000 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-4327
Practice Address - Country:US
Practice Address - Phone:360-856-7514
Practice Address - Fax:360-856-7515
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1399174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator