Provider Demographics
NPI:1003064155
Name:YEZZO, SUSAN E (AUD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:YEZZO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:E
Other - Last Name:KOSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:1140 LEXINGTON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9330
Mailing Address - Country:US
Mailing Address - Phone:502-867-7806
Mailing Address - Fax:502-867-7836
Practice Address - Street 1:1140 LEXINGTON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9330
Practice Address - Country:US
Practice Address - Phone:502-867-7806
Practice Address - Fax:502-867-7836
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0429231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY100073OtherKY LICENSE
KY0169Medicare PIN