Provider Demographics
NPI:1649461575
Name:FARRELL, SUSAN TORKE (MS/CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:TORKE
Last Name:FARRELL
Suffix:
Gender:F
Credentials:MS/CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 GREEN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-3625
Mailing Address - Country:US
Mailing Address - Phone:262-792-1874
Mailing Address - Fax:
Practice Address - Street 1:570 GREEN MEADOW DR
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-3625
Practice Address - Country:US
Practice Address - Phone:262-792-1874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI458-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI458-154OtherSPEECH PATH. LICENSE
WI42678500Medicaid