Provider Demographics
NPI:1689063109
Name:FARLEY, SUZANNE (MED CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:
Last Name:FARLEY
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:MS
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:DODD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED CCC-SLP
Mailing Address - Street 1:10903 GRAVELLY LAKE DR SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1341
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10903 GRAVELLY LAKE DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1341
Practice Address - Country:US
Practice Address - Phone:253-583-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60479294235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist