Provider Demographics
NPI:1154481190
Name:FRANK, SUSAN THOMAS (MA CCCSLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:THOMAS
Last Name:FRANK
Suffix:
Gender:F
Credentials:MA CCCSLP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:THOMAS
Other - Last Name:GLAZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCCSLP
Mailing Address - Street 1:1 JOHN MARSHALL DRIVE
Mailing Address - Street 2:MARSHALL UNIVERSITY SPEECH AND HEARING CENTER
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25755-2675
Mailing Address - Country:US
Mailing Address - Phone:304-696-3641
Mailing Address - Fax:304-696-2986
Practice Address - Street 1:1 JOHN MARSHALL DRIVE
Practice Address - Street 2:MARSHALL UNIVERSITY SPEECH AND HEARING CENTER
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25755-2675
Practice Address - Country:US
Practice Address - Phone:304-696-3641
Practice Address - Fax:304-696-2986
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP0868235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003863Medicaid