Provider Demographics
NPI:1518381987
Name:SUSKI, ALISSA SARA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALISSA
Middle Name:SARA
Last Name:SUSKI
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 1:28242 SHORE
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-4043
Mailing Address - Country:US
Mailing Address - Phone:626-272-9449
Mailing Address - Fax:
Practice Address - Street 1:5151 MURPHY CANYON RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4440
Practice Address - Country:US
Practice Address - Phone:626-272-9449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21041235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist