Provider Demographics
NPI:1598893620
Name:HOME, SUSAN BILLIE (MED, MMA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:BILLIE
Last Name:HOME
Suffix:
Gender:F
Credentials:MED, MMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8402 LUCERNE DR
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-4604
Mailing Address - Country:US
Mailing Address - Phone:440-543-5571
Mailing Address - Fax:
Practice Address - Street 1:4329 GREEN RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND HILLS
Practice Address - State:OH
Practice Address - Zip Code:44128-4884
Practice Address - Country:US
Practice Address - Phone:216-464-0950
Practice Address - Fax:216-464-7342
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP - 5614235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist