Provider Demographics
NPI:1770809675
Name:GRABOW, SUZAN (CCC-A)
Entity type:Individual
Prefix:
First Name:SUZAN
Middle Name:
Last Name:GRABOW
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W HIGHWAY 6
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-5591
Mailing Address - Country:US
Mailing Address - Phone:254-776-7744
Mailing Address - Fax:
Practice Address - Street 1:601 W HIGHWAY 6
Practice Address - Street 2:SUITE 106
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-5591
Practice Address - Country:US
Practice Address - Phone:254-776-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80281231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist