Provider Demographics
NPI:1538607718
Name:MCGREGOR, SUZANNE MARY (SLP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARY
Last Name:MCGREGOR
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 WENTWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32124-2060
Mailing Address - Country:US
Mailing Address - Phone:973-903-1377
Mailing Address - Fax:386-366-7456
Practice Address - Street 1:328 WENTWORTH AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32124-2060
Practice Address - Country:US
Practice Address - Phone:973-903-1377
Practice Address - Fax:386-366-7456
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 14234235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist