Provider Demographics
NPI:1356409510
Name:STEWART, SUSAN E (MS, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:E
Last Name:STEWART
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 198TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6762
Mailing Address - Country:US
Mailing Address - Phone:425-275-9071
Mailing Address - Fax:425-275-9045
Practice Address - Street 1:4230 198TH ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6762
Practice Address - Country:US
Practice Address - Phone:425-275-9071
Practice Address - Fax:425-275-9045
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00002780235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5852STOtherREGENCE PROVIDER NUMBER