Provider Demographics
NPI:1245546902
Name:O'CONNOR, SUSAN MARIAN (CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:MARIAN
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MILITARY TURNPIKE
Mailing Address - Street 2:PO BOX 455
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901
Mailing Address - Country:US
Mailing Address - Phone:518-561-7340
Mailing Address - Fax:
Practice Address - Street 1:MILITARY TURNPIKE
Practice Address - Street 2:CHAMPLAIN VALLEY EDUCATIONAL SERVICES
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901
Practice Address - Country:US
Practice Address - Phone:518-561-7340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009592-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist