Provider Demographics
NPI:1912055583
Name:WINSLOW-KING, SUZANNE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:WINSLOW-KING
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HAPPY HOLW
Mailing Address - Street 2:
Mailing Address - City:TIJERAS
Mailing Address - State:NM
Mailing Address - Zip Code:87059-7468
Mailing Address - Country:US
Mailing Address - Phone:505-281-8112
Mailing Address - Fax:505-281-8113
Practice Address - Street 1:8 HAPPY HOLW
Practice Address - Street 2:
Practice Address - City:TIJERAS
Practice Address - State:NM
Practice Address - Zip Code:87059-7468
Practice Address - Country:US
Practice Address - Phone:505-281-8112
Practice Address - Fax:505-281-8113
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM661235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000D4273Medicaid