Provider Demographics
NPI:1083083711
Name:FITZGERALD, SUZETTE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:
Last Name:FITZGERALD
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 1:4349 S ALTON CT
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1212
Mailing Address - Country:US
Mailing Address - Phone:303-880-0187
Mailing Address - Fax:
Practice Address - Street 1:4349 S ALTON CT
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1212
Practice Address - Country:US
Practice Address - Phone:303-880-0187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist