Provider Demographics
NPI:1760529614
Name:KAUFMAN, SUSAN SMITH (SLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:SMITH
Last Name:KAUFMAN
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 1:105 FOX HILL DR
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-8741
Mailing Address - Country:US
Mailing Address - Phone:803-530-2214
Mailing Address - Fax:803-788-4715
Practice Address - Street 1:105 FOX HILL DR
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-8741
Practice Address - Country:US
Practice Address - Phone:803-530-2214
Practice Address - Fax:803-788-4715
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2864235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3803Medicaid