Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PY00001969 | WA |
NPI | 1093853707 |
---|---|
Provider Name | Dr. Susan D. Kane-Ronning |
First Address | Bellingham, WA 98226-9412 |
Second Address | Bellingham, WA 98225-5203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7082290 | (05) | WA |
8918030 | LABOR AND INDUSTRIES (01) | WA |
S2208 | (02) |