Provider Demographics
NPI:1255858742
Name:OVERSTREET, SUZANNE JOY (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:JOY
Last Name:OVERSTREET
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-3910
Mailing Address - Country:US
Mailing Address - Phone:618-532-1907
Mailing Address - Fax:
Practice Address - Street 1:1100 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-4710
Practice Address - Country:US
Practice Address - Phone:618-533-7133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.011426235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist