Provider Demographics
NPI:1346617388
Name:DOWELL, SUSAN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DOWELL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 TIMOTHY LN
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:OK
Mailing Address - Zip Code:74730-5122
Mailing Address - Country:US
Mailing Address - Phone:918-306-2123
Mailing Address - Fax:
Practice Address - Street 1:1019 CHUCKWA DR
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2623
Practice Address - Country:US
Practice Address - Phone:580-924-8579
Practice Address - Fax:580-745-9357
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4382235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4382OtherOKLAHOMA STATE LICENSE FOR SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY
OK14041593OtherASHA LICENSE FOR CLINICAL COMPETENCE IN SPEECH-LANGUAGE PATHOLOGY