Individual
SUSAN JOHANNSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
15418 MAINT STREET, SUITE 303A, MILL CREEK, WA 98012
(425) 339-5453
(425) 252-4441
Mailing address
PO BOX 5127, EVERETT, WA 98206-5127
(425) 339-5453
(425) 252-4441
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PY61085331
WA
103TC0700X
Clinical Psychologist
Primary
PY61085331
WA
Other
Enumeration date
09/02/2020
Last updated
02/16/2023
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