Provider Demographics
NPI:1376811364
Name:ROSS, SUZANNE (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:SUZANNE
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 WINDWARD DR
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2332
Mailing Address - Country:US
Mailing Address - Phone:631-732-0582
Mailing Address - Fax:
Practice Address - Street 1:14 43RD ST
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-2325
Practice Address - Country:US
Practice Address - Phone:631-732-0582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010015235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist