Provider Demographics
NPI:1417676396
Name:WIATREK, SUSAN LYNDAL
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNDAL
Last Name:WIATREK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 E MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:KARNES CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78118-3228
Mailing Address - Country:US
Mailing Address - Phone:830-534-6455
Mailing Address - Fax:
Practice Address - Street 1:416 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:KARNES CITY
Practice Address - State:TX
Practice Address - Zip Code:78118-3228
Practice Address - Country:US
Practice Address - Phone:830-534-6455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11745235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist