Provider Demographics
NPI:1326152372
Name:MIDDLETON, SUSAN H (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:H
Last Name:MIDDLETON
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 1:1336 GREENWILLOW LN APT B8
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-5501
Mailing Address - Country:US
Mailing Address - Phone:847-254-7920
Mailing Address - Fax:847-356-7273
Practice Address - Street 1:1336 GREENWILLOW LN APT B8
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-5501
Practice Address - Country:US
Practice Address - Phone:847-254-7920
Practice Address - Fax:847-356-7273
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist