Provider Demographics
NPI:1477742054
Name:CRISAFULLI, SUZANNE GUNDERSON (MA)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:GUNDERSON
Last Name:CRISAFULLI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 SAINT VINCENT DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7654
Mailing Address - Country:US
Mailing Address - Phone:682-518-0021
Mailing Address - Fax:
Practice Address - Street 1:1521 N COOPER ST STE 210
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5522
Practice Address - Country:US
Practice Address - Phone:817-983-2550
Practice Address - Fax:817-983-2551
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51533237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter