Provider Demographics
NPI:1518154673
Name:WILEY, SUZANNE MICHELLE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:MICHELLE
Last Name:WILEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:246 CUPSAW DR
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-2322
Mailing Address - Country:US
Mailing Address - Phone:973-818-8511
Mailing Address - Fax:973-556-5526
Practice Address - Street 1:246 CUPSAW DR
Practice Address - Street 2:
Practice Address - City:RINGWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07456-2322
Practice Address - Country:US
Practice Address - Phone:973-818-8511
Practice Address - Fax:973-556-5526
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00351100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist