Provider Demographics
NPI:1922204544
Name:STACHO, SUSAN RENEE (MA, CCC SLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RENEE
Last Name:STACHO
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 1:11830 TALL PINES DR
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-8727
Mailing Address - Country:US
Mailing Address - Phone:440-286-3732
Mailing Address - Fax:
Practice Address - Street 1:11830 TALL PINES DR
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-8727
Practice Address - Country:US
Practice Address - Phone:440-286-3732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 2974235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist