Provider Demographics
NPI:1942230305
Name:STUDENEC, SUSAN R (MS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:STUDENEC
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4441 56TH ST N
Mailing Address - Street 2:
Mailing Address - City:KENNETH CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33709-5326
Mailing Address - Country:US
Mailing Address - Phone:727-541-7474
Mailing Address - Fax:
Practice Address - Street 1:HALEY VAMC (ASP-126)
Practice Address - Street 2:13000 BRUCE B DOWNS BLVD
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:813-972-2000
Practice Address - Fax:813-978-5212
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6053235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist