Provider Demographics
NPI:1538437603
Name:POULETTE, SUSANNE MARIE (MS IN ED)
Entity type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:MARIE
Last Name:POULETTE
Suffix:
Gender:F
Credentials:MS IN ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 VAN ANTWERP RD
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-5317
Mailing Address - Country:US
Mailing Address - Phone:518-377-4666
Mailing Address - Fax:518-377-4074
Practice Address - Street 1:1239 VAN ANTWERP RD
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-5317
Practice Address - Country:US
Practice Address - Phone:518-377-4666
Practice Address - Fax:518-377-4074
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005341235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist