Provider Demographics
NPI:1790835965
Name:GRUBER, SUSAN CHRISTINE (CCC SLP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:CHRISTINE
Last Name:GRUBER
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:14920 WESTMINSTER WAY N
Mailing Address - Street 2:#1A
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-6445
Mailing Address - Country:US
Mailing Address - Phone:206-769-9330
Mailing Address - Fax:206-306-9997
Practice Address - Street 1:14920 WESTMINSTER WAY N
Practice Address - Street 2:#1A
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-6445
Practice Address - Country:US
Practice Address - Phone:206-769-9330
Practice Address - Fax:206-306-9997
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL0002031235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist