Provider Demographics
NPI:1831221449
Name:WENGER, SUSAN ANNE (MS)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANNE
Last Name:WENGER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 KITTITAS HWY
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-8918
Mailing Address - Country:US
Mailing Address - Phone:509-962-9252
Mailing Address - Fax:509-962-9278
Practice Address - Street 1:421 N PEARL ST
Practice Address - Street 2:SUITE 219
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3193
Practice Address - Country:US
Practice Address - Phone:509-962-9252
Practice Address - Fax:509-962-9278
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4439101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health