Provider Demographics
NPI:1710168653
Name:BOLIVER, SUZANNE P (SLPA)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:P
Last Name:BOLIVER
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:FERRANTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 PENN ST
Mailing Address - Street 2:STE 12
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901
Mailing Address - Country:US
Mailing Address - Phone:321-768-6800
Mailing Address - Fax:321-768-6858
Practice Address - Street 1:1800 PENN ST
Practice Address - Street 2:STE 12
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-768-6800
Practice Address - Fax:321-768-6858
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI 13972355S0801X
FLSI13972355A2700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology Assistant
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant