Provider Demographics
NPI:1730171042
Name:COAN, SUZ GABRIELLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUZ
Middle Name:GABRIELLE
Last Name:COAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9833 NE 120TH PL
Mailing Address - Street 2:SUITE B
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4266
Mailing Address - Country:US
Mailing Address - Phone:425-820-8013
Mailing Address - Fax:
Practice Address - Street 1:9833 NE 120TH PL
Practice Address - Street 2:SUITE B
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4266
Practice Address - Country:US
Practice Address - Phone:425-820-8013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY3259103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist