Individual
DR. SUZANNE E JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AU.D.
Contact information
Practice address
550 17TH AVE, 5TH FLOOR, SEATTLE, WA 98122-5788
(206) 386-3880
(206) 386-3882
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 320-4426
(206) 568-7043
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
LD00003628
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0218398
STATE L&I PROVIDER ACCT #
WA
05
—
1092181
—
WA
05
—
500664133
—
OR
Enumeration date
07/03/2007
Last updated
02/10/2017
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