Provider Demographics
NPI:1619389996
Name:GROGAN-JOHNSON, SUSAN
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:GROGAN-JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:GROGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, CCC/SLP
Mailing Address - Street 1:SPEECH & HEARING CLINIC A104 CPA
Mailing Address - Street 2:KENT STATE UNIVERSITY
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44242-0001
Mailing Address - Country:US
Mailing Address - Phone:330-672-0250
Mailing Address - Fax:330-672-2643
Practice Address - Street 1:SPEECH & HEARING CLINIC A104 CPA
Practice Address - Street 2:KENT STATE UNIVERSITY
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44242-0001
Practice Address - Country:US
Practice Address - Phone:330-672-0250
Practice Address - Fax:330-672-2643
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-2760235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist