Provider Demographics
NPI:1356487391
Name:CLORE, SUSAN I C (MED)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:I C
Last Name:CLORE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19005 CARLTON DR
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-4141
Mailing Address - Country:US
Mailing Address - Phone:540-825-9279
Mailing Address - Fax:
Practice Address - Street 1:19005 CARLTON DR
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-4141
Practice Address - Country:US
Practice Address - Phone:540-825-9279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202001766235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist