Provider Demographics
NPI:1235805805
Name:SU, YUN-HSUAN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:YUN-HSUAN
Middle Name:
Last Name:SU
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:SHIRLEY
Other - Middle Name:
Other - Last Name:SU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:4732 BENNING ST
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-2527
Mailing Address - Country:US
Mailing Address - Phone:812-325-8731
Mailing Address - Fax:
Practice Address - Street 1:4732 BENNING ST
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-2527
Practice Address - Country:US
Practice Address - Phone:812-325-8731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021032004235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist