Provider Demographics
NPI:1730423716
Name:BREEN, SUSANNE MARIE (ND)
Entity type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:MARIE
Last Name:BREEN
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 1:11030 SW CAPITOL HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-8653
Mailing Address - Country:US
Mailing Address - Phone:503-477-7602
Mailing Address - Fax:971-288-1303
Practice Address - Street 1:11030 SW CAPITOL HWY STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-8653
Practice Address - Country:US
Practice Address - Phone:503-477-7602
Practice Address - Fax:971-288-1303
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3042175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath