Provider Demographics
NPI:1790248516
Name:WASSUM, SUSAN KNAP (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KNAP
Last Name:WASSUM
Suffix:
Gender:F
Credentials:MA, CCC-SLP
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Mailing Address - Street 1:915 COURT ST
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24504-1603
Mailing Address - Country:US
Mailing Address - Phone:434-515-5180
Mailing Address - Fax:434-522-2323
Practice Address - Street 1:915 COURT ST
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24504-1603
Practice Address - Country:US
Practice Address - Phone:434-515-5180
Practice Address - Fax:434-522-2323
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2202007910235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2202007910OtherVIRGINIA SPEECH-LANGUAGE PATHOLOGIST LICENSE