Provider Demographics
NPI:1659525376
Name:REILLY, SUSAN D (MS,CCC-A)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:REILLY
Suffix:
Gender:F
Credentials:MS,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SPRINGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-2507
Mailing Address - Country:US
Mailing Address - Phone:914-419-5544
Mailing Address - Fax:
Practice Address - Street 1:777 NO BROADWAY, SUITE 303
Practice Address - Street 2:PHELPS MEMORIAL HOSPITAL
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591
Practice Address - Country:US
Practice Address - Phone:914-366-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001018231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist