Individual
DR. SUZANNA JOLENE WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
2463 E GALA ST STE 100, MERIDIAN, ID 83642-5210
(208) 955-7333
Mailing address
3407 N RHONE PL, STAR, ID 83669-5797
(208) 994-2607
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
LCPC-6424
ID
103TC0700X
Clinical Psychologist
Primary
PSY-203922
ID
Other
Enumeration date
08/06/2013
Last updated
04/09/2024
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