Provider Demographics
NPI:1730518721
Name:SICKNER, SUZANNE
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:SICKNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:SICKNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, PSYD, MFTI
Mailing Address - Street 1:1453 16TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2715
Mailing Address - Country:US
Mailing Address - Phone:310-264-6646
Mailing Address - Fax:
Practice Address - Street 1:1453 16TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2715
Practice Address - Country:US
Practice Address - Phone:310-264-6646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program