Suzanna Jolene Waters, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY-203922 Issued in ID

Practice address

2463 E Gala St Ste 100
Meridian, ID 83642-5210

Phone

(208) 955-7333

NPI assigned

Aug 6, 2013

Last updated

Apr 9, 2024By 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 2

Addresses

Other names 1

• Ms. Suzanna Jolene Reed Former name

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Northwest Neurobehavioral Health, LLC

  • Clinical Social Worker
  • Meridian, ID
  • NPI 1013223445
  Medicare reassignment NPD
• Northwest Neurobehavioral Health PLLC

  • Clinical Psychologist
  • Boise, ID
  • NPI 1518102797
  NPD (past)

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

{
    "created_epoch": "1375747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712620800000",
    "number": "1275965881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3407 N RHONE PL",
            "city": "STAR",
            "state": "ID",
            "postal_code": "836695797",
            "telephone_number": "208-994-2607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2463 E GALA ST STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836425210",
            "telephone_number": "208-955-7333"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 W Fort St",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837024501",
            "country_code": "US",
            "telephone_number": "208-422-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATERS",
        "first_name": "SUZANNA",
        "middle_name": "JOLENE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-06",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ID",
            "license": "PSY-203922",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ID",
            "license": "LCPC-6424",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUZANNA",
            "last_name": "REED",
            "middle_name": "JOLENE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kohner Warren
• McKayleigh Wasia
• Watchdog LLC
• Water's Edge Counseling Center (Water's Edge Couseling Center)
• Aubrey Waterman, LCSW
• Amber Watkins, APRN-CNP
• Benjamin Watkins, PHARMD
• Benjamin Watson, PA-C
• Cyrilla Watson, RBT
• Kimberly Watson, NP

• Clinical Psychologist in Meridian, ID
• Providers in Meridian, ID by specialty
• Clinical Psychologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; 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.