Provider Demographics
NPI:1518311737
Name:MERINO, SUSAN (MA, CCC-SLP, COM)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MERINO
Suffix:
Gender:F
Credentials:MA, CCC-SLP, COM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 VISION PARK BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3021
Mailing Address - Country:US
Mailing Address - Phone:713-805-9602
Mailing Address - Fax:
Practice Address - Street 1:128 VISION PARK BLVD STE 250
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3021
Practice Address - Country:US
Practice Address - Phone:713-805-9602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102544235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist