Provider Demographics
NPI:1437282027
Name:BLOCKER, SUSAN ANN (MHS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ANN
Last Name:BLOCKER
Suffix:
Gender:F
Credentials:MHS CCC-SLP
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:ANN
Other - Last Name:SPESARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHS CCC-SLP
Mailing Address - Street 1:3106 KYRA LN
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60124
Mailing Address - Country:US
Mailing Address - Phone:847-841-3227
Mailing Address - Fax:
Practice Address - Street 1:3106 KYRA LN
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60124
Practice Address - Country:US
Practice Address - Phone:847-841-3227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2207425235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist