Provider Demographics
NPI:1447566856
Name:ANDERSEN, SUSAN MICHELLE (MS, CF-SLP)
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:MICHELLE
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 E MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2488
Mailing Address - Country:US
Mailing Address - Phone:630-584-7530
Mailing Address - Fax:630-584-7762
Practice Address - Street 1:3815 E MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2488
Practice Address - Country:US
Practice Address - Phone:630-584-7530
Practice Address - Fax:630-584-7762
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.001683235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL242.001683OtherSPEECH LANGUAGE AND HEARING SERVICE PROVIDER