Provider Demographics
NPI:1033792817
Name:VANSCIVER, SUZANNE A (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:A
Last Name:VANSCIVER
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 SALEM QUINTON RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NJ
Mailing Address - Zip Code:08079-1278
Mailing Address - Country:US
Mailing Address - Phone:856-297-6384
Mailing Address - Fax:
Practice Address - Street 1:84 E GRANT ST
Practice Address - Street 2:
Practice Address - City:WOODSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08098-1400
Practice Address - Country:US
Practice Address - Phone:856-297-6384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00245000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty