Provider Demographics
NPI:1013555663
Name:POPPEN, SUZANNE N (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:N
Last Name:POPPEN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:N
Other - Last Name:SCRIMENTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:411 CAMINO DEL RIO S STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3508
Mailing Address - Country:US
Mailing Address - Phone:619-574-8181
Mailing Address - Fax:619-574-0802
Practice Address - Street 1:411 CAMINO DEL RIO S STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3508
Practice Address - Country:US
Practice Address - Phone:619-574-8181
Practice Address - Fax:619-574-0802
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13337235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist