Provider Demographics
NPI:1245606938
Name:HAYDEN, SUSAN G (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:HAYDEN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 MOUNT COBB RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18436-3233
Mailing Address - Country:US
Mailing Address - Phone:570-955-8655
Mailing Address - Fax:
Practice Address - Street 1:1544 MOUNT COBB RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18436-3233
Practice Address - Country:US
Practice Address - Phone:570-955-8655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009974235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist