Provider Demographics
NPI:1700172095
Name:ROZWOD, SUSAN MEDAY (SLP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MEDAY
Last Name:ROZWOD
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 1:111 PERIDOT DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-3411
Mailing Address - Country:US
Mailing Address - Phone:315-487-3442
Mailing Address - Fax:
Practice Address - Street 1:400 SANDERSON DR
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-1644
Practice Address - Country:US
Practice Address - Phone:315-487-4633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006064-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist