Provider Demographics
NPI:1679687610
Name:LEA, SUZANNE BESS (PHD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:BESS
Last Name:LEA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2865
Mailing Address - Country:US
Mailing Address - Phone:405-204-2893
Mailing Address - Fax:
Practice Address - Street 1:1220 LOVERS LN
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2865
Practice Address - Country:US
Practice Address - Phone:405-204-2893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100508235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX01037544OtherASHA CCC
TX100508OtherSTATE SPEECH PATH LIC