Provider Demographics
NPI:1801094727
Name:VINING, SUSAN PATRICIA (MS CCC A)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:PATRICIA
Last Name:VINING
Suffix:
Gender:F
Credentials:MS CCC A
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:PATRICIA
Other - Last Name:VIREN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2323 GODDARD RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3237
Mailing Address - Country:US
Mailing Address - Phone:419-578-0657
Mailing Address - Fax:
Practice Address - Street 1:200 HEALTH CENTER BUILDING
Practice Address - Street 2:BOWLING GREEN STATE UNIVERSITY
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43403-0149
Practice Address - Country:US
Practice Address - Phone:419-372-2515
Practice Address - Fax:419-372-8089
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA 0860231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist