Provider Demographics
NPI:1841315124
Name:MERMELSTEIN, SUSAN (AUD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:MERMELSTEIN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 UNIVERSITY LAKE DRIVE, SUITE 220
Mailing Address - Street 2:ANMC AUDIOLOGY DEPARTMENT
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5926
Mailing Address - Country:US
Mailing Address - Phone:907-729-8508
Mailing Address - Fax:907-729-1474
Practice Address - Street 1:3801 UNIVERSITY LAKE DR STE 220
Practice Address - Street 2:ANMC AUDIOLOGY DEPARTMENT
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4658
Practice Address - Country:US
Practice Address - Phone:907-729-8508
Practice Address - Fax:907-729-1474
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK78231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1000400Medicaid
AKAU1178Medicaid