Provider Demographics
NPI:1548507429
Name:ORTHEL, SUSAN DIANE (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:DIANE
Last Name:ORTHEL
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 1:35606 NW 35TH CT
Mailing Address - Street 2:
Mailing Address - City:LA CENTER
Mailing Address - State:WA
Mailing Address - Zip Code:98629-3035
Mailing Address - Country:US
Mailing Address - Phone:360-263-4662
Mailing Address - Fax:
Practice Address - Street 1:13501 NE 28TH ST.
Practice Address - Street 2:EVERGREEN PUBLIC SCHOOLS
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98668
Practice Address - Country:US
Practice Address - Phone:360-604-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 00004118235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist