Provider Demographics
NPI:1306814165
Name:CRAIN, SUSAN M (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:CRAIN
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 LABURNUM AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-6130
Mailing Address - Country:US
Mailing Address - Phone:704-332-4834
Mailing Address - Fax:704-372-9653
Practice Address - Street 1:2519 LABURNUM AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6130
Practice Address - Country:US
Practice Address - Phone:704-578-8303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3741235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411450Medicaid