Provider Demographics
NPI:1235438912
Name:DIRKS, SUSAN LYNN (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:DIRKS
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 FLAMINGO CT
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-3759
Mailing Address - Country:US
Mailing Address - Phone:281-450-4943
Mailing Address - Fax:
Practice Address - Street 1:701 FLAMINGO CT
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-3759
Practice Address - Country:US
Practice Address - Phone:281-450-4943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16208235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist