Provider Demographics
NPI:1619178878
Name:ISSLER, SUSAN ELLIS (SLPMACCC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELLIS
Last Name:ISSLER
Suffix:
Gender:F
Credentials:SLPMACCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6534 LARUE PROSPECT RD S
Mailing Address - Street 2:BOX 172
Mailing Address - City:PROSPECT
Mailing Address - State:OH
Mailing Address - Zip Code:43342-9579
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7233 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7137
Practice Address - Country:US
Practice Address - Phone:330-498-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSP-0923235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist