Provider Demographics
NPI:1679608491
Name:CARR, SUSAN TALLMADGE (ND)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:TALLMADGE
Last Name:CARR
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 116TH AVE NE
Mailing Address - Street 2:STE 104
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3034
Mailing Address - Country:US
Mailing Address - Phone:425-454-0787
Mailing Address - Fax:425-454-7827
Practice Address - Street 1:1605 116TH AVE NE
Practice Address - Street 2:STE 104
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3034
Practice Address - Country:US
Practice Address - Phone:425-454-0787
Practice Address - Fax:425-454-7827
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001477175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath