Provider Demographics
NPI:1225156425
Name:MIZIKER, SUSAN FRUGONE (MA, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:FRUGONE
Last Name:MIZIKER
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:J
Other - Last Name:FRUGONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CCC-A
Mailing Address - Street 1:4638 LEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-1536
Mailing Address - Country:US
Mailing Address - Phone:818-761-9100
Mailing Address - Fax:
Practice Address - Street 1:6333 WILSHIRE BLVD
Practice Address - Street 2:SUITE 309
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5702
Practice Address - Country:US
Practice Address - Phone:323-651-5107
Practice Address - Fax:323-651-4169
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1281231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGAU000320Medicaid
CAWAU1281AMedicare ID - Type UnspecifiedMEDICARE MEMBER ID