Provider Demographics
NPI:1770930331
Name:WELLS, SUZANNE MARIE (MA SLP CCC)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:MARIE
Last Name:WELLS
Suffix:
Gender:F
Credentials:MA SLP CCC
Other - Prefix:MISS
Other - First Name:SUZANNE
Other - Middle Name:MARIE
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 HERD DRIVE
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938
Mailing Address - Country:US
Mailing Address - Phone:978-376-0822
Mailing Address - Fax:978-312-6630
Practice Address - Street 1:25 HERD DRIVE
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938
Practice Address - Country:US
Practice Address - Phone:978-376-0822
Practice Address - Fax:978-312-6630
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MA76481235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist