Provider Demographics
NPI:1700090446
Name:DOROFEY, SUSAN C (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:DOROFEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15919 VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-5658
Mailing Address - Country:US
Mailing Address - Phone:408-778-2608
Mailing Address - Fax:
Practice Address - Street 1:9300 WREN AVE
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-7636
Practice Address - Country:US
Practice Address - Phone:408-848-5161
Practice Address - Fax:408-846-6833
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 12642235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist