Provider Demographics
NPI:1932256088
Name:ANDREWS, SUSAN BETH (MED,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:BETH
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:MED,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:P.O.BOX 710159
Mailing Address - Street 2:
Mailing Address - City:MAXEYS
Mailing Address - State:GA
Mailing Address - Zip Code:30671
Mailing Address - Country:US
Mailing Address - Phone:706-759-3928
Mailing Address - Fax:
Practice Address - Street 1:291 CHERRY STREET
Practice Address - Street 2:
Practice Address - City:STEPHENS
Practice Address - State:GA
Practice Address - Zip Code:30306
Practice Address - Country:US
Practice Address - Phone:706-759-3928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP001280235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist