Provider Demographics
NPI:1083862338
Name:HADDAD, SUSAN GILL (MS, CCC, SLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:GILL
Last Name:HADDAD
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 1:5640 MONTANA AVE STE G
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3329
Mailing Address - Country:US
Mailing Address - Phone:915-633-8301
Mailing Address - Fax:915-591-6696
Practice Address - Street 1:5640 MONTANA AVE STE G
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-3329
Practice Address - Country:US
Practice Address - Phone:915-633-8301
Practice Address - Fax:915-591-6696
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100706235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist