Provider Demographics
NPI:1083011761
Name:CULLEN, SUSAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:CULLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 S ROCKY RIVER DR
Mailing Address - Street 2:# 602
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-2556
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 S ROCKY RIVER DR
Practice Address - Street 2:# 602
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-2556
Practice Address - Country:US
Practice Address - Phone:216-338-4627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9746235Z00000X
TX110823235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110823OtherLICENSE NUMBER
OH9746OtherLICENSE NUMBER