Provider Demographics
NPI:1336379155
Name:CHUBAK, SUSAN REBECCA (MSSPLCCC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:REBECCA
Last Name:CHUBAK
Suffix:
Gender:F
Credentials:MSSPLCCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WALDORF CT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2422
Mailing Address - Country:US
Mailing Address - Phone:718-434-7198
Mailing Address - Fax:
Practice Address - Street 1:12 WALDORF CT
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2422
Practice Address - Country:US
Practice Address - Phone:718-434-7198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014613235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist