Provider Demographics
NPI:1114162328
Name:HALSETH, SUSAN L (CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:HALSETH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 5TH ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-1301
Mailing Address - Country:US
Mailing Address - Phone:715-381-6963
Mailing Address - Fax:
Practice Address - Street 1:1011 5TH ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-1301
Practice Address - Country:US
Practice Address - Phone:715-381-6963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3019-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist