Provider Demographics
NPI:1477671816
Name:CRISTODERO, SUZANNE CHRISTINE (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:CHRISTINE
Last Name:CRISTODERO
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22350 HWY 1084
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435
Mailing Address - Country:US
Mailing Address - Phone:985-630-2438
Mailing Address - Fax:985-898-0701
Practice Address - Street 1:22350 HWY 1084
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70435
Practice Address - Country:US
Practice Address - Phone:985-630-2438
Practice Address - Fax:985-898-0701
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12032884235Z00000X
LA5007235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1478121Medicaid