Provider Demographics
NPI:1952793481
Name:VALENTINE, SUSAN MARIE (CCC-L-SLP,TSHH)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:CCC-L-SLP,TSHH
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARIE
Other - Last Name:BARTELT-VALENTINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:49 SAWMILL CT
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:NY
Mailing Address - Zip Code:14059-9421
Mailing Address - Country:US
Mailing Address - Phone:716-867-7124
Mailing Address - Fax:
Practice Address - Street 1:51 SAINT JOHNS PARKSIDE ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14210-2515
Practice Address - Country:US
Practice Address - Phone:716-828-9560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008419-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist