Provider Demographics
NPI:1073179453
Name:HUGHES, SUSAN KATHLEEN (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KATHLEEN
Last Name:HUGHES
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:KATHLEEN
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3904 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613-8512
Mailing Address - Country:US
Mailing Address - Phone:256-374-4225
Mailing Address - Fax:
Practice Address - Street 1:285 CHATEAU DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6401
Practice Address - Country:US
Practice Address - Phone:866-849-4608
Practice Address - Fax:256-203-5991
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-11
Last Update Date:2019-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2847235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist