Provider Demographics
NPI:1659530301
Name:GLENN, SUZANNE LYNN (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:LYNN
Last Name:GLENN
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 1:4851 GRAPEVINE WAY
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3363
Mailing Address - Country:US
Mailing Address - Phone:954-826-8565
Mailing Address - Fax:
Practice Address - Street 1:4851 GRAPEVINE WAY
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33331-3363
Practice Address - Country:US
Practice Address - Phone:954-826-8565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-07
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 4422235Z00000X
FLSA 9942222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist