Provider Demographics
NPI:1013273705
Name:CLARK, SUZANNE (AUD)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042
Mailing Address - Country:US
Mailing Address - Phone:513-422-6516
Mailing Address - Fax:513-422-5199
Practice Address - Street 1:1044 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042
Practice Address - Country:US
Practice Address - Phone:513-422-6516
Practice Address - Fax:513-422-5199
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.01084231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist