Provider Demographics
NPI:1891845574
Name:SCOGGINS, SUSAN MARIE (MED CCCSLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:SCOGGINS
Suffix:
Gender:F
Credentials:MED CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 VERSANTE CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-6034
Mailing Address - Country:US
Mailing Address - Phone:979-229-2544
Mailing Address - Fax:281-890-5568
Practice Address - Street 1:13 VERSANTE CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-6034
Practice Address - Country:US
Practice Address - Phone:979-776-2872
Practice Address - Fax:281-890-5568
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14107235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist