Provider Demographics
NPI:1295833200
Name:MOWRY, SUZANNE P (SLP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:P
Last Name:MOWRY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:PATRICIA
Other - Last Name:INGALLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSC, S-LP(C)
Mailing Address - Street 1:PO BOX 1599
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1599
Mailing Address - Country:US
Mailing Address - Phone:207-404-8200
Mailing Address - Fax:
Practice Address - Street 1:6 TELCOM DR
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3072
Practice Address - Country:US
Practice Address - Phone:207-941-2850
Practice Address - Fax:207-941-2852
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP3463235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3953Medicaid