Provider Demographics
NPI:1124395785
Name:MIKULAS, SUZANNE MARIE (MA, TSSLD, SLP-CCC)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIE
Last Name:MIKULAS
Suffix:
Gender:F
Credentials:MA, TSSLD, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SPIRAL RD
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-2241
Mailing Address - Country:US
Mailing Address - Phone:631-807-2530
Mailing Address - Fax:
Practice Address - Street 1:110 SPIRAL RD
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-2241
Practice Address - Country:US
Practice Address - Phone:631-807-2530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist