Provider Demographics
NPI:1518180967
Name:FERGUSON, SUSAN (MSE CCC-SLP)
Entity Type:Individual
Prefix:PROF
First Name:SUSAN
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MSE CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SUMMERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-8445
Mailing Address - Country:US
Mailing Address - Phone:501-593-1587
Mailing Address - Fax:
Practice Address - Street 1:210 SUMMERWOOD DR
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-8445
Practice Address - Country:US
Practice Address - Phone:501-593-1587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR561235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist