Provider Demographics
NPI:1528409794
Name:FAINE-HODDESON, SUSAN DALE (MA, CCC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:DALE
Last Name:FAINE-HODDESON
Suffix:
Gender:F
Credentials:MA, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MANOR POND LN
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533-2412
Mailing Address - Country:US
Mailing Address - Phone:914-478-3735
Mailing Address - Fax:
Practice Address - Street 1:5 MANOR POND LN
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NY
Practice Address - Zip Code:10533-2412
Practice Address - Country:US
Practice Address - Phone:914-478-3735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003289-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist