Provider Demographics
NPI:1265753685
Name:STEWART, SUSAN VERONICA (CCC-S)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:VERONICA
Last Name:STEWART
Suffix:
Gender:F
Credentials:CCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 SANDERS AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-1732
Mailing Address - Country:US
Mailing Address - Phone:518-374-9802
Mailing Address - Fax:
Practice Address - Street 1:7 WEMBLEY CT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3851
Practice Address - Country:US
Practice Address - Phone:518-464-6302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004208235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist