Provider Demographics
NPI:1942223441
Name:MCGAHEE, SUSAN KELLY (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KELLY
Last Name:MCGAHEE
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 1:4448 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-1216
Mailing Address - Country:US
Mailing Address - Phone:800-207-0802
Mailing Address - Fax:407-515-6537
Practice Address - Street 1:4448 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-1216
Practice Address - Country:US
Practice Address - Phone:407-513-3000
Practice Address - Fax:407-515-6537
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 8294235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889785900Medicaid