Provider Demographics
NPI:1043323116
Name:TOLER, SUSAN DENISE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DENISE
Last Name:TOLER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MCGARVEY
Other - Last Name:TOLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:1481 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2803
Mailing Address - Country:US
Mailing Address - Phone:317-988-2233
Mailing Address - Fax:317-988-0018
Practice Address - Street 1:1481 W 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2803
Practice Address - Country:US
Practice Address - Phone:317-988-2233
Practice Address - Fax:317-988-0018
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22001629A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN22001629AOtherSPEECH STATE LICENSE