Provider Demographics
NPI:1811100696
Name:ADAM, SUSAN ANONA (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ANONA
Last Name:ADAM
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 1:1309 ROCKBRIDGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:NORRFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-1339
Mailing Address - Country:US
Mailing Address - Phone:757-489-8522
Mailing Address - Fax:
Practice Address - Street 1:CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS
Practice Address - Street 2:601 CHILDREN'S LANE
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507
Practice Address - Country:US
Practice Address - Phone:757-668-9137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202001505235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist