Provider Demographics
NPI:1205007754
Name:INDEN, SUSAN WENICK (MA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:WENICK
Last Name:INDEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8020 CASTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2732
Mailing Address - Country:US
Mailing Address - Phone:215-722-4111
Mailing Address - Fax:215-722-3163
Practice Address - Street 1:8020 CASTOR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2732
Practice Address - Country:US
Practice Address - Phone:215-722-4111
Practice Address - Fax:215-722-3163
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000406L231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier