Provider Demographics
NPI:1275876419
Name:KUBANCIK, SUZANNE MARIE (MSCCC-A)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:MARIE
Last Name:KUBANCIK
Suffix:
Gender:F
Credentials:MSCCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SPRING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-8538
Mailing Address - Country:US
Mailing Address - Phone:304-695-1058
Mailing Address - Fax:740-695-0889
Practice Address - Street 1:109 PLAZA DR
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-7713
Practice Address - Country:US
Practice Address - Phone:740-695-1058
Practice Address - Fax:740-695-0889
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X
PAAT005978231H00000X
WVA0120231H00000X
OHA01028231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist