Provider Demographics
NPI:1558899229
Name:YOCUM, SUSAN C (SLP COND2016219-SP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:YOCUM
Suffix:
Gender:F
Credentials:SLP COND2016219-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S CANAL ST
Mailing Address - Street 2:
Mailing Address - City:SPENCERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45887-1123
Mailing Address - Country:US
Mailing Address - Phone:419-204-0330
Mailing Address - Fax:
Practice Address - Street 1:405 N WATER ST
Practice Address - Street 2:
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879-1251
Practice Address - Country:US
Practice Address - Phone:419-399-4656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND-2016219-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist