Provider Demographics
NPI:1538129515
Name:POWERS, SUSAN M (MA,CCC,SLP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:POWERS
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 1:1357 COOK AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-2567
Mailing Address - Country:US
Mailing Address - Phone:216-221-7051
Mailing Address - Fax:
Practice Address - Street 1:1929A E ROYALTON RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW HTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2809
Practice Address - Country:US
Practice Address - Phone:440-838-0990
Practice Address - Fax:440-838-8440
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-2772235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0849916Medicaid
OH314380051030OtherCARESOURCE INS. CO.