Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1175 | WA |
Y | 103T00000X | Psychologist | 1175 | WA |
NPI | 1013046598 |
---|---|
Provider Name | Dr. Suzanne Lee Taylor |
First Address | Camano Island, WA 98282-8437 |
Second Address | Camano Island, WA 98282-8437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 25/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
91-2140849 | SERVICE CORPORATION (01) | WA |