Provider Demographics
NPI:1912318551
Name:TESTA, SUSAN (MA CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:TESTA
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DEBARTOLO PL.
Mailing Address - Street 2:MAHONING COUNTY EDUCATIONAL SERVICE CENTER
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512
Mailing Address - Country:US
Mailing Address - Phone:330-503-4798
Mailing Address - Fax:
Practice Address - Street 1:100 DEBARTOLO PL.
Practice Address - Street 2:MAHONING COUNTY EDUCATIONAL SERVICE CENTER
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512
Practice Address - Country:US
Practice Address - Phone:330-503-4798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.3341235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist