Provider Demographics
NPI:1518265867
Name:MOSCA, SUSAN E (MS,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:E
Last Name:MOSCA
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 WITCH HAZEL DR
Mailing Address - Street 2:
Mailing Address - City:DEEP RIVER
Mailing Address - State:CT
Mailing Address - Zip Code:06417-1552
Mailing Address - Country:US
Mailing Address - Phone:860-526-4939
Mailing Address - Fax:860-526-4939
Practice Address - Street 1:33 WITCH HAZEL DR
Practice Address - Street 2:
Practice Address - City:DEEP RIVER
Practice Address - State:CT
Practice Address - Zip Code:06417-1552
Practice Address - Country:US
Practice Address - Phone:860-526-4939
Practice Address - Fax:860-526-4939
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001773235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist