Susan Janette Poole, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY00002439 Issued in WA

Practice address

5909 Orchard St W
Tacoma, WA 98467-3824

Phone

(253) 475-6021

Fax

(253) 474-1871

NPI assigned

Jan 29, 2007

Last updated

Nov 9, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Susan Poole, PHD, PLLC

  dba Sage Spark Psychology

  • Psychologist
  • Tacoma, WA
  • NPI 1932843422
  NPD Authorized official
• Western Psychological and Counseling Services LLC

  dba LifeStance Health

  • Clinical Psychologist
  • Tacoma, WA
  • NPI 1912008178
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667952000000",
    "number": "1265578363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3213 N 31ST ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984075901",
            "telephone_number": "253-905-1882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5909 ORCHARD ST W",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984673824",
            "telephone_number": "253-475-6021",
            "fax_number": "253-474-1871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POOLE",
        "first_name": "SUSAN",
        "middle_name": "JANETTE",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-29",
        "last_updated": "2022-11-09",
        "certification_date": "2022-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "PY00002439",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Georgina Comin Ponce de Leon, MD
• Marcus C Ponce de Leon, M.D.
• Mario Natale Ponticello, DPM
• Justin Pool, PSY.D.
• Lorraine Phillips Poole
• Teresa Michelle Poole, ARNP
• Zion Heart Poole
• Jesse Ryan Pooler, M.P.T.
• Kampol Poophawatanakik, LAC
• Stephen E Poore, MD

• Psychologist in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.