Provider Demographics
NPI:1568127801
Name:FUSCO, SUSAN B (AUD/CCC/A)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:B
Last Name:FUSCO
Suffix:
Gender:F
Credentials:AUD/CCC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 CANYONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-5502
Mailing Address - Country:US
Mailing Address - Phone:817-277-4567
Mailing Address - Fax:
Practice Address - Street 1:1849 CENTRAL DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6017
Practice Address - Country:US
Practice Address - Phone:817-223-3635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50422231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist