Provider Demographics
NPI:1073641791
Name:OSBORNE, SUSAN MICHELLE (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MICHELLE
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-6922
Mailing Address - Country:US
Mailing Address - Phone:270-492-8519
Mailing Address - Fax:270-492-8519
Practice Address - Street 1:3120 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-6922
Practice Address - Country:US
Practice Address - Phone:270-492-8519
Practice Address - Fax:270-492-8519
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2008-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2390235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist