Individual
SUSAN K SINNOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LMFT, LD
Contact information
Practice address
790 E 5TH ST, COQUILLE, OR 97423-1755
(541) 396-3111
(541) 396-5222
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-0000
(541) 267-5151
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
T0517
OR
133V00000X
Registered Dietitian
90
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407812365
GROUP NPI NUMBER
OR
01
—
90
LICENSE-DIETITIAN
OR
01
—
930635514
GROUP TAX ID FOR BILLING
OR
01
—
R0000WFBTV
GROUP MEDICARE PIN NUMBER
OR
01
—
T0517
LICENSE-MARRIAGE & FAMILY THERAPIST
OR
Enumeration date
02/23/2007
Last updated
04/27/2011
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