Provider Demographics
NPI:1841625175
Name:GLADSJO, SUZANNE LOUISE (SLP)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:LOUISE
Last Name:GLADSJO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 GORMLEY ST
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-4541
Mailing Address - Country:US
Mailing Address - Phone:509-741-9551
Mailing Address - Fax:
Practice Address - Street 1:235 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1961
Practice Address - Country:US
Practice Address - Phone:509-663-8161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60337899235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist