Provider Demographics
NPI:1790942613
Name:MANSFIELD, SUSAN HOPE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:HOPE
Last Name:MANSFIELD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7887 FARRINGTON HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:14723-9810
Mailing Address - Country:US
Mailing Address - Phone:716-296-5363
Mailing Address - Fax:
Practice Address - Street 1:7887 FARRINGTON HOLLOW RD
Practice Address - Street 2:
Practice Address - City:CHERRY CREEK
Practice Address - State:NY
Practice Address - Zip Code:14723-9810
Practice Address - Country:US
Practice Address - Phone:716-296-5363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003872-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist