Provider Demographics
NPI:1508646613
Name:NOVOTNEY, SUSAN M (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:NOVOTNEY
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 1:10789 CHARDON RD
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9751
Mailing Address - Country:US
Mailing Address - Phone:440-285-4705
Mailing Address - Fax:
Practice Address - Street 1:1515 BROOKSTONE BLVD
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-8210
Practice Address - Country:US
Practice Address - Phone:440-226-8869
Practice Address - Fax:440-226-8882
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-6800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist