Provider Demographics
NPI:1922285634
Name:KLIEWER, SUZANNE LEE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:LEE
Last Name:KLIEWER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-2911
Mailing Address - Country:US
Mailing Address - Phone:402-690-4370
Mailing Address - Fax:
Practice Address - Street 1:1105 S 18TH ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-2911
Practice Address - Country:US
Practice Address - Phone:402-690-4370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001003861235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist