Provider Demographics
NPI:1790919264
Name:LEVENTER, SUSAN LEON (PHD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LEON
Last Name:LEVENTER
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2353
Mailing Address - Country:US
Mailing Address - Phone:201-530-0296
Mailing Address - Fax:
Practice Address - Street 1:671 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-2353
Practice Address - Country:US
Practice Address - Phone:201-530-0296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00368300235Z00000X
NY00496235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist