Provider Demographics
NPI:1457462368
Name:DEJERNETT, SUSANNE SCHLANKEY (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:SCHLANKEY
Last Name:DEJERNETT
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:SUSANNE
Other - Middle Name:
Other - Last Name:SCHLANKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:3103 BEE CAVES RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5586
Mailing Address - Country:US
Mailing Address - Phone:512-327-2083
Mailing Address - Fax:512-327-0808
Practice Address - Street 1:3103 BEE CAVES RD
Practice Address - Street 2:SUITE 104
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5586
Practice Address - Country:US
Practice Address - Phone:512-327-2083
Practice Address - Fax:512-327-0808
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17743235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX17743OtherSTATE LICENSE
09143816OtherASHA MEMBERSHIP NUMBER
TX2051690-01Medicaid