Provider Demographics
NPI:1902083579
Name:PAUL, SUSAN P (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:P
Last Name:PAUL
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 COTTONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-2325
Mailing Address - Country:US
Mailing Address - Phone:610-564-1127
Mailing Address - Fax:
Practice Address - Street 1:4 COTTONWOOD CT
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-2325
Practice Address - Country:US
Practice Address - Phone:610-564-1127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL002246L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist