Provider Demographics
NPI:1700225935
Name:WAIZENHOFER, SUSAN (MA)
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:
Last Name:WAIZENHOFER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 EVERGREEN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-5750
Mailing Address - Country:US
Mailing Address - Phone:513-948-2308
Mailing Address - Fax:
Practice Address - Street 1:8000 EVERGREEN RIDGE DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-5750
Practice Address - Country:US
Practice Address - Phone:513-948-2308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9626235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist