Provider Demographics
NPI:1578702379
Name:MCGARY-FYNMORE, SUSAN JANE (SLP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JANE
Last Name:MCGARY-FYNMORE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 E MISSOURI AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2734
Mailing Address - Country:US
Mailing Address - Phone:602-393-0520
Mailing Address - Fax:602-393-0523
Practice Address - Street 1:1190 E MISSOURI AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2734
Practice Address - Country:US
Practice Address - Phone:602-393-0520
Practice Address - Fax:602-393-0523
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP1210235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist