Provider Demographics
NPI:1376663971
Name:LEE, SUZANNE GOWDY
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:GOWDY
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:GOWDY
Other - Last Name:WEED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:2304 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2732
Mailing Address - Country:US
Mailing Address - Phone:360-423-6809
Mailing Address - Fax:360-425-4450
Practice Address - Street 1:1655 HUDSON ST
Practice Address - Street 2:SUITE I
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2949
Practice Address - Country:US
Practice Address - Phone:360-423-8310
Practice Address - Fax:360-425-4450
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00001939235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00075960OtherASHS CERT.CLINICAL COMP