Provider Demographics
NPI:1134570658
Name:VERNER, SUSAN ELIZABETH (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:VERNER
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ELIZABETH
Other - Last Name:SHEPPARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, CCC-SLP
Mailing Address - Street 1:1560 HENTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1371
Mailing Address - Country:US
Mailing Address - Phone:419-665-1968
Mailing Address - Fax:419-866-5663
Practice Address - Street 1:1560 HENTHORNE DR
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1371
Practice Address - Country:US
Practice Address - Phone:419-866-5196
Practice Address - Fax:419-866-5663
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.3296235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0392980Medicaid
OH1609899061OtherCOMPANY NPI