Provider Demographics
NPI:1629127451
Name:TERRY, SUSAN E (AUD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:TERRY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 5TH AVENUE N.
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713
Mailing Address - Country:US
Mailing Address - Phone:727-323-2471
Mailing Address - Fax:727-323-3577
Practice Address - Street 1:4107 5TH AVENUE N.
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-1140
Practice Address - Country:US
Practice Address - Phone:727-323-2471
Practice Address - Fax:727-323-3577
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY126231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL087001300Medicaid
FL087001300Medicaid