Individual provider Active NPI

Susan Katalin Toth Patiejunas, PH.D.

  • Clinical Psychologist
  • Issaquah, WA
National Provider Identifier
1679658496
Registry record updated Aug 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY00002368 Issued in WA
Practice address
1700 NW Gilman Blvd
Suite 205
Issaquah, WA 98027-5349
Phone
(425) 241-5531
Fax
(425) 427-2477
NPI assigned
Oct 27, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 8, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PY00002368 WA Primary

Addresses

Primary practice location

1700 NW Gilman Blvd
Suite 205
Issaquah, WA 98027-5349

Mailing address

1700 NW Gilman Blvd
Suite 205
Issaquah, WA 98027-5349
Phone (425) 241-5531

Other identifiers 2

IdentifierTypeStateIssuer
227550OtherINTERNAL ID-MOTOR VEHICLE ID
8323859MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PY00002368WAMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407456000000",
    "number": "1679658496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 NW GILMAN BLVD",
            "address_2": "SUITE 205",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980275349",
            "telephone_number": "425-241-5531",
            "fax_number": "425-427-2477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 NW GILMAN BLVD",
            "address_2": "SUITE 205",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980275349",
            "telephone_number": "425-241-5531",
            "fax_number": "425-427-2477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOTH PATIEJUNAS",
        "first_name": "SUSAN",
        "middle_name": "KATALIN",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-27",
        "last_updated": "2014-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY00002368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INTERNAL ID-MOTOR VEHICLE ID",
            "identifier": "227550",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8323859",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Issaquah, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2014; 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.