Provider Demographics
NPI:1932426962
Name:MASON, SUSAN SHAW (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:SHAW
Last Name:MASON
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 1:11888 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:AR
Mailing Address - Zip Code:72732-9739
Mailing Address - Country:US
Mailing Address - Phone:479-359-0013
Mailing Address - Fax:
Practice Address - Street 1:220 S 5TH ST
Practice Address - Street 2:SPECIAL SERVICES CENTER
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-4467
Practice Address - Country:US
Practice Address - Phone:479-631-3515
Practice Address - Fax:479-631-3504
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist