Provider Demographics
NPI:1912947722
Name:HEALEA, SUSAN K (MA-CCCA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:HEALEA
Suffix:
Gender:F
Credentials:MA-CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2402
Mailing Address - Country:US
Mailing Address - Phone:360-423-0960
Mailing Address - Fax:360-423-8778
Practice Address - Street 1:820 11TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2402
Practice Address - Country:US
Practice Address - Phone:360-423-0960
Practice Address - Fax:360-423-8778
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00000957231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA06222OtherREGENCE
WA9029919Medicaid
WA0123184OtherL&I