Provider Demographics
NPI:1376705228
Name:RANDLE, SUZANN MICHELLE (SLP)
Entity Type:Individual
Prefix:MISS
First Name:SUZANN
Middle Name:MICHELLE
Last Name:RANDLE
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 1:235 CR 251
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866
Mailing Address - Country:US
Mailing Address - Phone:662-231-3220
Mailing Address - Fax:662-869-7153
Practice Address - Street 1:235 CR 251
Practice Address - Street 2:
Practice Address - City:SALTILLO
Practice Address - State:MS
Practice Address - Zip Code:38866
Practice Address - Country:US
Practice Address - Phone:662-231-3220
Practice Address - Fax:662-869-7153
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3215235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist