Provider Demographics
NPI:1497803688
Name:HERMAN, SUZANNE C (SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:C
Last Name:HERMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 S FLEISHEL AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-4440
Mailing Address - Country:US
Mailing Address - Phone:903-581-5421
Mailing Address - Fax:903-581-4515
Practice Address - Street 1:2117 S FLEISHEL AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4440
Practice Address - Country:US
Practice Address - Phone:903-581-5421
Practice Address - Fax:903-581-4515
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11594235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX005616001Medicaid
TX1609080613OtherNPI GROUP
TX752886218OtherTAX IDENTIFICATION NUMBER
TX87327T GROUP 0072ELOtherBLUE CROSS BLUE SHIELD
TX1194961888OtherNPI 2-ORGANIZATION