Provider Demographics
NPI:1598144024
Name:DAVIS-CARR, SUSAN (BC HIS 3679)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DAVIS-CARR
Suffix:
Gender:F
Credentials:BC HIS 3679
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 BRIARTREE WAY
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621-1009
Mailing Address - Country:US
Mailing Address - Phone:916-725-0222
Mailing Address - Fax:916-910-9979
Practice Address - Street 1:6601 BRIARTREE WAY
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-1009
Practice Address - Country:US
Practice Address - Phone:916-725-0222
Practice Address - Fax:916-910-9979
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHIS 3679237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist