Provider Demographics
NPI:1780682930
Name:PHILLIPS, SUSAN L (PHD CCCA)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PHD CCCA
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 26170 UNCG
Mailing Address - Street 2:300 FERGUSON BUILDING
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27402-6170
Mailing Address - Country:US
Mailing Address - Phone:336-334-5184
Mailing Address - Fax:336-334-4475
Practice Address - Street 1:524 HIGHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27402-6170
Practice Address - Country:US
Practice Address - Phone:336-334-5184
Practice Address - Fax:336-334-4475
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2007-08-20
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-08-20
Provider Licenses
StateLicense IDTaxonomies
NC4916231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4916OtherAUDIOLOGY LICENSE
NC953OtherHEARING AID LICENSE