Provider Demographics
NPI:1639495468
Name:OWENS, SUSAN M (MA, CCC-SLP SPEECH P)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:OWENS
Suffix:
Gender:F
Credentials:MA, CCC-SLP SPEECH P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 419161
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-9161
Mailing Address - Country:US
Mailing Address - Phone:314-523-5390
Mailing Address - Fax:
Practice Address - Street 1:226 S. WOODS MILL RD.
Practice Address - Street 2:SUITE 37W
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3442
Practice Address - Country:US
Practice Address - Phone:314-523-5390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01674235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist