Provider Demographics
NPI:1730792839
Name:TALBOT, SUSAN VICTORIA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:VICTORIA
Last Name:TALBOT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5435
Mailing Address - Country:US
Mailing Address - Phone:401-523-0265
Mailing Address - Fax:
Practice Address - Street 1:400 MASSASOIT AVE STE 113
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-2040
Practice Address - Country:US
Practice Address - Phone:401-490-7610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00563235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist