Provider Demographics
NPI:1033390612
Name:SHOULDERS, SUSAN E (MS/ CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:E
Last Name:SHOULDERS
Suffix:
Gender:F
Credentials:MS/ CCC-SLP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:E
Other - Last Name:BOYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS/CCC-SLP
Mailing Address - Street 1:PO BOX 91286
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-0286
Mailing Address - Country:US
Mailing Address - Phone:502-472-1194
Mailing Address - Fax:
Practice Address - Street 1:1123 N BARDSTOWN RD
Practice Address - Street 2:SUITE #2
Practice Address - City:MT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-7843
Practice Address - Country:US
Practice Address - Phone:502-472-1194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X, 222Q00000X, 224Z00000X, 225X00000X, 235Z00000X, 252Y00000X
KY3419235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty