Provider Demographics
NPI:1598150948
Name:MARKO, SUSAN ELISABETH (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ELISABETH
Last Name:MARKO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4752 CRYSTAL BROOK DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-5380
Mailing Address - Country:US
Mailing Address - Phone:615-397-3867
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER EAST SOUTH TOWER
Practice Address - Street 2:1215 21ST AVENUE SOUTH, SUITE 6209
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-8718
Practice Address - Country:US
Practice Address - Phone:615-936-7925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP 0000003519235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist