Provider Demographics
NPI:1124214531
Name:LARRICK, SUSAN I
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:LARRICK
Suffix:I
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 1:33 EAST SLOPE RD
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11709
Mailing Address - Country:US
Mailing Address - Phone:516-628-3248
Mailing Address - Fax:
Practice Address - Street 1:33 EAST SLOPE RD
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11709
Practice Address - Country:US
Practice Address - Phone:516-628-3248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005779235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist