Provider Demographics
NPI:1831358951
Name:WENTZEL, SUSAN M (MED/AUDIOLOGIST)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:WENTZEL
Suffix:
Gender:F
Credentials:MED/AUDIOLOGIST
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 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-413-2514
Mailing Address - Fax:843-292-0038
Practice Address - Street 1:800 E CHEVES ST
Practice Address - Street 2:SUITE 370
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2650
Practice Address - Country:US
Practice Address - Phone:843-413-2514
Practice Address - Fax:843-413-2528
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2111237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1831358951Medicare PIN