Provider Demographics
NPI:1841518297
Name:WEINBERGER, SUSANNA ROSE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:ROSE
Last Name:WEINBERGER
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 1:11150 ACAMA ST
Mailing Address - Street 2:#24
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-3060
Mailing Address - Country:US
Mailing Address - Phone:310-270-5717
Mailing Address - Fax:
Practice Address - Street 1:11150 ACAMA ST
Practice Address - Street 2:#24
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-3060
Practice Address - Country:US
Practice Address - Phone:310-270-5717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17237235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist