Provider Demographics
NPI:1548413909
Name:SUSAN M. FOSNOT, PHD SPEECH THERAPIST INC.
Entity Type:Organization
Organization Name:SUSAN M. FOSNOT, PHD SPEECH THERAPIST INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FOSNOT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD , CCC-SLP, BCS-F
Authorized Official - Phone:818-884-9110
Mailing Address - Street 1:5850 CANOGA AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6554
Mailing Address - Country:US
Mailing Address - Phone:818-884-9110
Mailing Address - Fax:818-884-9119
Practice Address - Street 1:5850 CANOGA AVE FL 4
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6554
Practice Address - Country:US
Practice Address - Phone:818-884-9110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP2661OtherSPEECH -LANUAGE PATHOLOGY, AUDIOLOGY & HEARING AID DISPENERS BOARD