Provider Demographics
NPI:1356794374
Name:DOTY, SUSAN (MS/CCC-SLP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DOTY
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 1:2712 S SANDSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-6511
Mailing Address - Country:US
Mailing Address - Phone:605-359-6144
Mailing Address - Fax:
Practice Address - Street 1:2712 S SANDSTONE CIR
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-6511
Practice Address - Country:US
Practice Address - Phone:605-359-6144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD352-SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist