Provider Demographics
NPI:1881848893
Name:LUETY, SUZANNE GEORGINA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:GEORGINA
Last Name:LUETY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:LITTLE YORK
Mailing Address - State:NY
Mailing Address - Zip Code:13087-0108
Mailing Address - Country:US
Mailing Address - Phone:607-749-4740
Mailing Address - Fax:
Practice Address - Street 1:6250 LITTLE YORK LAKE RD
Practice Address - Street 2:
Practice Address - City:PREBLE
Practice Address - State:NY
Practice Address - Zip Code:13141
Practice Address - Country:US
Practice Address - Phone:607-749-4740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008629-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist