Provider Demographics
NPI:1386868396
Name:BLEDSOE, SUZANNE D (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:D
Last Name:BLEDSOE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11985 HAYNESVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:AR
Mailing Address - Zip Code:71749-8923
Mailing Address - Country:US
Mailing Address - Phone:870-599-9060
Mailing Address - Fax:
Practice Address - Street 1:214 HOPE LANDING RD
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-8725
Practice Address - Country:US
Practice Address - Phone:870-862-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1823235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152474721Medicaid