Provider Demographics
NPI:1811200769
Name:ECKHART, SUSAN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:ECKHART
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 CIRRUS DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7997
Mailing Address - Country:US
Mailing Address - Phone:706-955-3000
Mailing Address - Fax:
Practice Address - Street 1:730 CIRRUS DR
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-7997
Practice Address - Country:US
Practice Address - Phone:706-955-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006194235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist