Provider Demographics
NPI:1619726775
Name:POGUE, SUSAN ANDREA
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANDREA
Last Name:POGUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 W SIESTA WAY
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7875
Mailing Address - Country:US
Mailing Address - Phone:602-703-6385
Mailing Address - Fax:
Practice Address - Street 1:4135 S POWER RD STE 115
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-3625
Practice Address - Country:US
Practice Address - Phone:480-389-4516
Practice Address - Fax:480-542-0629
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA136282355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant