Provider Demographics
NPI:1689055766
Name:KASDORF, SUSAN, (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:SUSAN,
Middle Name:
Last Name:KASDORF
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 1:24512 EBELDEN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-3744
Mailing Address - Country:US
Mailing Address - Phone:661-713-5009
Mailing Address - Fax:
Practice Address - Street 1:24512 EBELDEN AVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-3744
Practice Address - Country:US
Practice Address - Phone:661-713-5009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7810235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist