Provider Demographics
NPI:1316215080
Name:GRIESMANN, SUSAN A (MSED SLP CCC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:A
Last Name:GRIESMANN
Suffix:
Gender:F
Credentials:MSED SLP CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 BEACH RD
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:NY
Mailing Address - Zip Code:14006-9702
Mailing Address - Country:US
Mailing Address - Phone:716-549-2300
Mailing Address - Fax:
Practice Address - Street 1:959 BEACH RD
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:NY
Practice Address - Zip Code:14006-9702
Practice Address - Country:US
Practice Address - Phone:716-549-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3381550235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist