Provider Demographics
NPI:1023014685
Name:HERR, SUSAN L (AUD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:HERR
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 BOARDMAN-CANFIELD RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512
Mailing Address - Country:US
Mailing Address - Phone:330-726-3339
Mailing Address - Fax:330-726-0482
Practice Address - Street 1:3622 BELMONT AVE.
Practice Address - Street 2:SUITE 19
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505
Practice Address - Country:US
Practice Address - Phone:330-759-3593
Practice Address - Fax:330-759-4032
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-000910-L231H00000X
OHA01053231H00000X
PAAT000910L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2915199Medicaid
000000573568OtherANTHEM
OH0746376Medicaid
PA0018232000001Medicaid
OH2097985Medicaid
OH2097985Medicaid
PA0018232000001Medicaid
OH0884191Medicare ID - Type Unspecified