Provider Demographics
NPI:1881810786
Name:HUPPER, SUSAN E
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:HUPPER
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 1:80 BELL RD
Mailing Address - Street 2:
Mailing Address - City:WRIGHT CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63390-3202
Mailing Address - Country:US
Mailing Address - Phone:636-791-2150
Mailing Address - Fax:
Practice Address - Street 1:80 BELL RD
Practice Address - Street 2:
Practice Address - City:WRIGHT CITY
Practice Address - State:MO
Practice Address - Zip Code:63390-3202
Practice Address - Country:US
Practice Address - Phone:636-791-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0371250235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1881810786Medicaid
MO468867809Medicaid