Provider Demographics
NPI:1346896149
Name:RAUMA, SUSAN KATHRYN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KATHRYN
Last Name:RAUMA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3378 N 3300 E
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:ID
Mailing Address - Zip Code:83341-5266
Mailing Address - Country:US
Mailing Address - Phone:760-900-9280
Mailing Address - Fax:
Practice Address - Street 1:3378 N 3300 E
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:ID
Practice Address - Zip Code:83341-5266
Practice Address - Country:US
Practice Address - Phone:760-900-9280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20396235Z00000X
IDSLP-3856235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist