Provider Demographics
NPI:1457654717
Name:GRAMA, SUSAN LYNN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:GRAMA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18933 NASHVILLE ST
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-2630
Mailing Address - Country:US
Mailing Address - Phone:818-360-0415
Mailing Address - Fax:818-360-4372
Practice Address - Street 1:18933 NASHVILLE ST
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-2630
Practice Address - Country:US
Practice Address - Phone:818-360-0415
Practice Address - Fax:818-360-4372
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 15194235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP 15194OtherSPEECH PATHOLOGY LICENSE