Provider Demographics
NPI:1487738712
Name:DAVID, SUSANNAH EMILY (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSANNAH
Middle Name:EMILY
Last Name:DAVID
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10620 OLYMPIC PL
Mailing Address - Street 2:
Mailing Address - City:ANDERSON ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98303-8770
Mailing Address - Country:US
Mailing Address - Phone:253-514-1143
Mailing Address - Fax:
Practice Address - Street 1:9601 STEILACOOM BLVD SW
Practice Address - Street 2:WESTERN STATE HOSPITAL WARD C-5
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98498-7213
Practice Address - Country:US
Practice Address - Phone:253-756-2359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3562103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical