Basic Information
| Provider Information | |||||||||
| NPI: | 1306923453 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAXA | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9315 GOOD SPRING DR | ||||||||
| Address2: | |||||||||
| City: | PERRY HALL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211289827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105831515 | ||||||||
| FaxNumber: | 4105832491 | ||||||||
| Practice Location | |||||||||
| Address1: | 1026 CROMWELL BRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212863308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105831515 | ||||||||
| FaxNumber: | 4105832491 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 2384 | MD | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.