Provider Demographics
NPI:1073521860
Name:MENOZI, SUSAN ROGAN (AUD)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ROGAN
Last Name:MENOZI
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:ROGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:1501 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2742
Mailing Address - Country:US
Mailing Address - Phone:630-969-1677
Mailing Address - Fax:630-969-4383
Practice Address - Street 1:1501 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2742
Practice Address - Country:US
Practice Address - Phone:630-969-1677
Practice Address - Fax:630-969-4383
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000150237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL360670Medicare ID - Type UnspecifiedAUDIOLOGIST