Provider Demographics
NPI:1912103292
Name:SYLVESTER, SUZANNE VOTH (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:VOTH
Last Name:SYLVESTER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 US ROUTE 1
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7219
Mailing Address - Country:US
Mailing Address - Phone:207-219-8300
Mailing Address - Fax:207-219-8301
Practice Address - Street 1:144 US ROUTE 1
Practice Address - Street 2:SUITE 4
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7219
Practice Address - Country:US
Practice Address - Phone:207-219-8300
Practice Address - Fax:207-219-8301
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1227235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME23409000Medicaid
MEE100281935OtherMEDICARE PTAN