Basic Information
| Provider Information | |||||||||
| NPI: | 1124569611 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRUBB | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | ANN-WESTOVER | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MSW, LICSWA, GMHP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WESTOVER | ||||||||
| OtherFirstName: | SUSAN | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MSW, LICSWA,GMHP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 2569 | ||||||||
| Address2: | SUNRISE SERVICES INC | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252124200 | ||||||||
| FaxNumber: | 4252124201 | ||||||||
| Practice Location | |||||||||
| Address1: | 2326 RUCKER AVE # 303 | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982012723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257899587 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2017 | ||||||||
| LastUpdateDate: | 12/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 12/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | SC60656968 | WA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.