Provider Demographics
NPI:1528374568
Name:POULIOT, SUZANNE MARGUERITE
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARGUERITE
Last Name:POULIOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4148 RITTENHOUSE LANE
Mailing Address - Street 2:PO BOX 1025
Mailing Address - City:SKIPPACK
Mailing Address - State:PA
Mailing Address - Zip Code:19474-1025
Mailing Address - Country:US
Mailing Address - Phone:610-584-5552
Mailing Address - Fax:
Practice Address - Street 1:4148 RITTENHOUSE LANE
Practice Address - Street 2:
Practice Address - City:SKIPPACK
Practice Address - State:PA
Practice Address - Zip Code:19474-1025
Practice Address - Country:US
Practice Address - Phone:610-584-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL000241L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist