Provider Demographics
NPI:1710421201
Name:AKIN, SUSAN (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:AKIN
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 1:2122 HIGHWAY 35 W
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-9272
Mailing Address - Country:US
Mailing Address - Phone:870-723-3712
Mailing Address - Fax:
Practice Address - Street 1:280 CLYDE ROSS DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-5702
Practice Address - Country:US
Practice Address - Phone:870-367-4030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR747235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist