Provider Demographics
NPI:1689902348
Name:LANKFORD, SUSAN W (SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:W
Last Name:LANKFORD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 W. BANK G.Q. ST.
Mailing Address - Street 2:
Mailing Address - City:GRANITE QUARRY
Mailing Address - State:NC
Mailing Address - Zip Code:28146-8789
Mailing Address - Country:US
Mailing Address - Phone:704-209-3810
Mailing Address - Fax:
Practice Address - Street 1:518 WEST BANK G.Q. ST.
Practice Address - Street 2:
Practice Address - City:GRANITE QUARRY
Practice Address - State:NC
Practice Address - Zip Code:28146-8789
Practice Address - Country:US
Practice Address - Phone:704-209-3810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4182235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist