Provider Demographics
NPI:1942476627
Name:MCGILL, SUZANNE M (SLP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:MCGILL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17284 LANE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-1232
Mailing Address - Country:US
Mailing Address - Phone:616-780-0549
Mailing Address - Fax:
Practice Address - Street 1:17284 LANE AVE
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-1232
Practice Address - Country:US
Practice Address - Phone:616-780-0549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5762235Z00000X
MI7101003946235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist