Provider Demographics
NPI:1811140197
Name:KINSELLA, SUSAN MICHELLE (MS)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MICHELLE
Last Name:KINSELLA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 MAIN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1764
Mailing Address - Country:US
Mailing Address - Phone:631-261-3472
Mailing Address - Fax:
Practice Address - Street 1:321 GARLAND DR
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-6238
Practice Address - Country:US
Practice Address - Phone:631-261-3472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016965235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist