Provider Demographics
NPI:1396024048
Name:SUSSMAN, LAUREN M (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:M
Last Name:SUSSMAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 S COLLEGE ST
Mailing Address - Street 2:UNIT 1419
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6245
Mailing Address - Country:US
Mailing Address - Phone:609-658-0989
Mailing Address - Fax:
Practice Address - Street 1:1312 S COLLEGE ST
Practice Address - Street 2:UNIT 1419
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-6245
Practice Address - Country:US
Practice Address - Phone:609-658-0989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021235-1235Z00000X
NC10989235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist