Basic Information
| Provider Information | |||||||||
| NPI: | 1912358557 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAZEKAS | ||||||||
| FirstName: | SUZANNE | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6352 WILLIAMS RD | ||||||||
| Address2: | |||||||||
| City: | LOWVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133674803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3155345096 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25059 WOOLWORTH ST | ||||||||
| Address2: | |||||||||
| City: | CARTHAGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136199597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154935000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2016 | ||||||||
| LastUpdateDate: | 06/24/2016 | ||||||||
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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 | 025747 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.