Provider Demographics
NPI:1689688061
Name:NEALON, SUSAN M (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:NEALON
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 1:1050 MARYVALE DR
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2324
Mailing Address - Country:US
Mailing Address - Phone:716-631-0300
Mailing Address - Fax:
Practice Address - Street 1:1050 MARYVALE DR
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-2324
Practice Address - Country:US
Practice Address - Phone:716-631-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist