Provider Demographics
NPI:1861648263
Name:DABO, SUSAN LOUISE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LOUISE
Last Name:DABO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:LOUISE
Other - Last Name:HAUGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:510 E. NORTH BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-4114
Mailing Address - Country:US
Mailing Address - Phone:614-261-5482
Mailing Address - Fax:614-263-5365
Practice Address - Street 1:510 E. NORTH BROADWAY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-4114
Practice Address - Country:US
Practice Address - Phone:614-263-5151
Practice Address - Fax:614-263-5365
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 8302235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0094740Medicaid
OH0094740Medicaid