Provider Demographics
NPI:1235218256
Name:SUAREZ, JON DAVID (MS, F/AAA)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:DAVID
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:MS, F/AAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6609 STATE ROUTE 56
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3547
Mailing Address - Country:US
Mailing Address - Phone:315-508-4327
Mailing Address - Fax:315-262-0300
Practice Address - Street 1:6609 STATE ROUTE 56
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-3574
Practice Address - Country:US
Practice Address - Phone:315-508-4327
Practice Address - Fax:315-262-0300
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002042-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist