Provider Demographics
NPI:1932221116
Name:MITCHELL, SUSAN ELIZABETH (LMP)
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 ALDER AVE
Mailing Address - Street 2:UNIT 10
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-3079
Mailing Address - Country:US
Mailing Address - Phone:425-286-3888
Mailing Address - Fax:
Practice Address - Street 1:112 ALDER AVE
Practice Address - Street 2:UNIT 10
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-3079
Practice Address - Country:US
Practice Address - Phone:425-286-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017838174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00017838OtherMASSAGE LICENSE