Basic Information
| Provider Information | |||||||||
| NPI: | 1083859763 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCOTT | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.S.,CCC/SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 WINDEMERE RD | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132191447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3155596902 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6723 TOWPATH RD | ||||||||
| Address2: | |||||||||
| City: | EAST SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130579506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154251004 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2008 | ||||||||
| LastUpdateDate: | 06/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 010445 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.