Provider Demographics
NPI:1770733727
Name:PICONE, SUSAN M (MS, CCC, SLP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:PICONE
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 1:17 ANN ELIZABETH DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10992-1043
Mailing Address - Country:US
Mailing Address - Phone:845-496-0555
Mailing Address - Fax:
Practice Address - Street 1:17 ANN ELIZABETH DR
Practice Address - Street 2:
Practice Address - City:WASHINGTONVILLE
Practice Address - State:NY
Practice Address - Zip Code:10992-1043
Practice Address - Country:US
Practice Address - Phone:845-496-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008910235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist