Provider Demographics
NPI:1417193756
Name:KESEL SQUIRES, SUSAN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KESEL SQUIRES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:KESEL
Other - Last Name:SQUIRES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:442 FRENCH ST
Mailing Address - Street 2:
Mailing Address - City:PARISH
Mailing Address - State:NY
Mailing Address - Zip Code:13131-3246
Mailing Address - Country:US
Mailing Address - Phone:315-558-1664
Mailing Address - Fax:
Practice Address - Street 1:159 W 1ST ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2045
Practice Address - Country:US
Practice Address - Phone:315-342-9575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006098-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist