Provider Demographics
NPI:1639357411
Name:ECKARDT, SUSAN KATHLEEN (AUD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:KATHLEEN
Last Name:ECKARDT
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 1:4201 TORRANCE BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4504
Mailing Address - Country:US
Mailing Address - Phone:310-540-4327
Mailing Address - Fax:310-316-2685
Practice Address - Street 1:4201 TORRANCE BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4504
Practice Address - Country:US
Practice Address - Phone:310-540-4327
Practice Address - Fax:310-316-2685
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2502237600000X
CAHA7269237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWAU2502AMedicare UPIN