Susan M Shaddick, M.A., MFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

37864 Issued in CA

Practice address

621 Cherry St
Santa Rosa, CA 95404-4202

Phone

(707) 884-9706

Fax

(707) 884-1930

NPI assigned

Dec 2, 2009

Sex

Female

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

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

{
    "created_epoch": "1259712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269993600000",
    "number": "1487982419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35501 S HIGHWAY 1 UNIT 23",
            "city": "GUALALA",
            "state": "CA",
            "postal_code": "954459545",
            "telephone_number": "707-889-3442",
            "fax_number": "707-884-1930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 CHERRY ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954044202",
            "telephone_number": "707-884-9706",
            "fax_number": "707-884-1930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHADDICK",
        "first_name": "SUSAN",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "M.A., MFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-12-02",
        "last_updated": "2010-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "37864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott A Sewell, MD
• Jessica Sewnath
• Frederick K. Seydel, MD
• SG Homecare, Inc
• Eiann Sha, PHARMD
• Sharilyn Renae Shaeffer, MFT
• Anal A Shah, DPT
• Anish Sunderrajan Shah, M.D
• Avni A Shah, MD
• Mansi R Shah, M.D.

• Marriage & Family Therapist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.