Provider Demographics
NPI:1437571379
Name:ZYLSTRA, SUSAN CLAYTON (MCD, CC-SLP #5731)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:CLAYTON
Last Name:ZYLSTRA
Suffix:
Gender:F
Credentials:MCD, CC-SLP #5731
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 KNOX PLACE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711
Mailing Address - Country:US
Mailing Address - Phone:909-621-0439
Mailing Address - Fax:
Practice Address - Street 1:842 KNOX PLACE
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711
Practice Address - Country:US
Practice Address - Phone:909-621-0439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASLP5731235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist