Provider Demographics
NPI:1700068863
Name:COCHRANE, SUSAN MARY (MA/CCC/SLP; BRS-FD)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARY
Last Name:COCHRANE
Suffix:
Gender:F
Credentials:MA/CCC/SLP; BRS-FD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8619 NORTHSHORE DR
Mailing Address - Street 2:
Mailing Address - City:HONEOYE
Mailing Address - State:NY
Mailing Address - Zip Code:14471-9803
Mailing Address - Country:US
Mailing Address - Phone:585-229-5235
Mailing Address - Fax:585-229-2985
Practice Address - Street 1:8619 NORTHSHORE DR
Practice Address - Street 2:
Practice Address - City:HONEOYE
Practice Address - State:NY
Practice Address - Zip Code:14471-9803
Practice Address - Country:US
Practice Address - Phone:585-229-5235
Practice Address - Fax:585-229-2985
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7550235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist