Provider Demographics
NPI:1770620973
Name:SMITH, SUSAN ROCHELLE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ROCHELLE
Last Name:SMITH
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:PO BOX 3578
Mailing Address - Street 2:
Mailing Address - City:CAREFREE
Mailing Address - State:AZ
Mailing Address - Zip Code:85377-3578
Mailing Address - Country:US
Mailing Address - Phone:602-750-4414
Mailing Address - Fax:
Practice Address - Street 1:11808 N 64TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5010
Practice Address - Country:US
Practice Address - Phone:480-484-3200
Practice Address - Fax:480-484-3201
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP1555235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ626880Medicaid