Provider Demographics
NPI:1457975310
Name:LAURITSEN, SUZANNE ELAINE
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:ELAINE
Last Name:LAURITSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W 5TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-6651
Mailing Address - Country:US
Mailing Address - Phone:918-203-3313
Mailing Address - Fax:918-512-4082
Practice Address - Street 1:117 W 5TH ST STE 1
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-6651
Practice Address - Country:US
Practice Address - Phone:918-203-3313
Practice Address - Fax:918-512-4089
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2692235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12027458OtherASHA
OK2692OtherOK BOARD OF EXAMINERS FOR SPEECH-LANGUAGE & AUDIOLOGY