Provider Demographics
NPI:1275881955
Name:HUXTABLE, SUSAN J (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:HUXTABLE
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:PO BOX 59
Mailing Address - Street 2:
Mailing Address - City:WEST WINFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:13491-0059
Mailing Address - Country:US
Mailing Address - Phone:315-822-6748
Mailing Address - Fax:
Practice Address - Street 1:588 STATE ROUTE 51
Practice Address - Street 2:
Practice Address - City:WEST WINFIELD
Practice Address - State:NY
Practice Address - Zip Code:13491-2600
Practice Address - Country:US
Practice Address - Phone:315-822-6748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005846-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist