Provider Demographics
NPI:1932714490
Name:SUH, JANE (MS, CF-SLP)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:
Last Name:SUH
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26200 REDLANDS BLVD APT 138
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7763
Mailing Address - Country:US
Mailing Address - Phone:213-500-5672
Mailing Address - Fax:
Practice Address - Street 1:10431 COMMERCE ST STE A
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-0110
Practice Address - Country:US
Practice Address - Phone:909-783-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14803235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist