1366581431 NPI number — SUSAN MAJESKI LCSW

Table of content: SUSAN MAJESKI LCSW (NPI 1366581431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366581431 NPI number — SUSAN MAJESKI LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAJESKI
Provider First Name:
SUSAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366581431
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
306 E 7TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RITZVILLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99169-1620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-610-6401
Provider Business Mailing Address Fax Number:
509-659-0556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 N 1ST AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
SANDPOINT
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83864-1456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-610-6401
Provider Business Practice Location Address Fax Number:
509-659-0556
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LCSW 26922 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: L5691 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010153183 . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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