Provider Demographics
NPI:1629502059
Name:FAIST, SUSAN KATHERINE
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KATHERINE
Last Name:FAIST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1084 HERITAGE TRCE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-8598
Mailing Address - Country:US
Mailing Address - Phone:513-282-6014
Mailing Address - Fax:
Practice Address - Street 1:1084 HERITAGE TRCE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-8598
Practice Address - Country:US
Practice Address - Phone:513-282-6014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-7597235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist