Provider Demographics
NPI:1336263151
Name:TRAHAN, SUZANNE GLASS (AUD, SLP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:GLASS
Last Name:TRAHAN
Suffix:
Gender:F
Credentials:AUD, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1562 LEYCESTER DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-5751
Mailing Address - Country:US
Mailing Address - Phone:225-766-9847
Mailing Address - Fax:
Practice Address - Street 1:3940 PRESCOTT RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-5143
Practice Address - Country:US
Practice Address - Phone:225-355-4461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2817235Z00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1317896Medicaid
LA1317993Medicaid