Provider Demographics
NPI:1396746814
Name:KASUNICK, SUSAN G (MA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:KASUNICK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-0567
Mailing Address - Country:US
Mailing Address - Phone:216-464-5160
Mailing Address - Fax:216-464-5982
Practice Address - Street 1:18660 BAGLEY RD
Practice Address - Street 2:SUITE 404
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3480
Practice Address - Country:US
Practice Address - Phone:440-243-3600
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00578231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist