Provider Demographics
NPI:1053631226
Name:BEGIN, SUSAN GALLION (MA CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:GALLION
Last Name:BEGIN
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 1:110 SAWTOOTH LN
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5986
Mailing Address - Country:US
Mailing Address - Phone:386-677-0689
Mailing Address - Fax:
Practice Address - Street 1:110 SAWTOOTH LN
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5986
Practice Address - Country:US
Practice Address - Phone:386-677-0689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6929235Z00000X, 222Q00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency