Provider Demographics
NPI:1568798122
Name:BEAN, SUSAN LANZARA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LANZARA
Last Name:BEAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:LANZARA
Other - Last Name:FASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21987 PEEPSOCK RD
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-1048
Mailing Address - Country:US
Mailing Address - Phone:603-547-3311
Mailing Address - Fax:
Practice Address - Street 1:21987 PEEPSOCK RD
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-1048
Practice Address - Country:US
Practice Address - Phone:603-547-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1019235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7101008644OtherSLP LICENSE
NH3076438Medicaid
MESP1706OtherSLP LICENSE
NH1019OtherSLP LICENSE