Provider Demographics
NPI:1457618407
Name:SALAM, SUSAN MORGAN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MORGAN
Last Name:SALAM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARIE
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:44715 PRENTICE DR
Mailing Address - Street 2:#772
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20146
Mailing Address - Country:US
Mailing Address - Phone:252-495-1004
Mailing Address - Fax:
Practice Address - Street 1:20943 KILLAWOG TER
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-7157
Practice Address - Country:US
Practice Address - Phone:571-310-5953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006758235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist