Provider Demographics
NPI:1679213409
Name:OKAMOTO, SUSAN CAROLINE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:CAROLINE
Last Name:OKAMOTO
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:CAROLINE
Other - Last Name:ABRAHAMS-CLAXTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:91 CUSSETA HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:BOX SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:31801
Mailing Address - Country:US
Mailing Address - Phone:762-207-0665
Mailing Address - Fax:
Practice Address - Street 1:91 CUSSETA HIGHWAY
Practice Address - Street 2:
Practice Address - City:BOX SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:31801
Practice Address - Country:US
Practice Address - Phone:762-207-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP011747235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty