Provider Demographics
NPI:1780845479
Name:HIPPCHEN, SUSAN KAE
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAE
Last Name:HIPPCHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:KAE
Other - Last Name:BRUNDIGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:124 CRAIGHILL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-5521
Mailing Address - Country:US
Mailing Address - Phone:304-724-9963
Mailing Address - Fax:
Practice Address - Street 1:124 CRAIGHILL DR
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-5521
Practice Address - Country:US
Practice Address - Phone:304-724-9963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-1083235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist