Provider Demographics
NPI:1689166936
Name:FOSNOT, SUSAN MEYERS (PHD , CCC-SLP, BCS-F)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MEYERS
Last Name:FOSNOT
Suffix:
Gender:F
Credentials:PHD , CCC-SLP, BCS-F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29651 MULHOLLAND HWY
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-3003
Mailing Address - Country:US
Mailing Address - Phone:818-884-9110
Mailing Address - Fax:
Practice Address - Street 1:5850 CANOGA AVE FL 4
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6554
Practice Address - Country:US
Practice Address - Phone:818-884-9110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-02
Last Update Date:2018-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP2661235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP2661OtherSPEECH -LANUAGE PATHOLOGY, AUDIOLOGY & HEARING AID DISPENERS BOARD
CA00454611OtherAMERICAN SPEECH LANUAGE & HEARING ASSOCIATION