1366788168 NPI number — MRS. SUSAN KAY STROUD M.ED; ED.S.

Table of content: MRS. SUSAN KAY STROUD M.ED; ED.S. (NPI 1366788168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366788168 NPI number — MRS. SUSAN KAY STROUD M.ED; ED.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STROUD
Provider First Name:
SUSAN
Provider Middle Name:
KAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED; ED.S.
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:
1366788168
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 S. MAIN ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COUPEVILLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98239-3518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-678-4409
Provider Business Mailing Address Fax Number:
360-678-0540

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 S. MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COUPEVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98239-3518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-678-4409
Provider Business Practice Location Address Fax Number:
360-678-0540
Provider Enumeration Date:
12/26/2012

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: 101YS0200X , with the licence number:  ESA-376284F , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TS0200X , with the licence number: ESA-376284F , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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