Provider Demographics
NPI:1083952121
Name:STANLEY, SUSAN PLASTER (MED CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:PLASTER
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 DUNHILL CT
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-7339
Mailing Address - Country:US
Mailing Address - Phone:843-664-9175
Mailing Address - Fax:
Practice Address - Street 1:1012 CONGAREE DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5768
Practice Address - Country:US
Practice Address - Phone:843-664-8169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3278235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist