Provider Demographics
NPI:1013423755
Name:SARGEANT, SUSAN NELSON (MS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:NELSON
Last Name:SARGEANT
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 1:1318 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5453
Mailing Address - Country:US
Mailing Address - Phone:540-371-4696
Mailing Address - Fax:
Practice Address - Street 1:11600 CATHARPIN RD
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22553-3607
Practice Address - Country:US
Practice Address - Phone:540-786-9817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2230000413235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist