Provider Demographics
NPI:1750668034
Name:CRAFT, SUSAN IRENE (HIS)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:IRENE
Last Name:CRAFT
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:IRENE
Other - Last Name:BOLGIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:605 W GIBSON ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-4909
Mailing Address - Country:US
Mailing Address - Phone:409-384-2383
Mailing Address - Fax:409-384-2378
Practice Address - Street 1:605 W GIBSON ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-4909
Practice Address - Country:US
Practice Address - Phone:903-241-0378
Practice Address - Fax:409-384-2378
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80339237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist