Provider Demographics
NPI:1366498255
Name:WARD, SUZAN L (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZAN
Middle Name:L
Last Name:WARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 851413
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73085-1413
Mailing Address - Country:US
Mailing Address - Phone:405-245-0156
Mailing Address - Fax:405-265-4041
Practice Address - Street 1:1000 WINNIPEG DR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-5434
Practice Address - Country:US
Practice Address - Phone:405-245-0156
Practice Address - Fax:405-265-4041
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK474235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100657640AOtherOKLAHOMA HEALTH CARE AUTH