Provider Demographics
NPI:1659431609
Name:MENGWASSER, CLAIRE SUZANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CLAIRE
Middle Name:SUZANNE
Last Name:MENGWASSER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 CHICAGO RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-1222
Mailing Address - Country:US
Mailing Address - Phone:573-634-3825
Mailing Address - Fax:
Practice Address - Street 1:505 E 5TH ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-1703
Practice Address - Country:US
Practice Address - Phone:573-592-2571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003013944235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist