Provider Demographics
NPI:1982790911
Name:MOODY, SUSAN ANNETTE (SLP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ANNETTE
Last Name:MOODY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 4321 CLUSTER
Mailing Address - Street 2:
Mailing Address - City:PORT ISABEL
Mailing Address - State:TX
Mailing Address - Zip Code:78578
Mailing Address - Country:US
Mailing Address - Phone:956-943-5160
Mailing Address - Fax:956-943-5161
Practice Address - Street 1:1900 W SCHUNIOR ST
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541
Practice Address - Country:US
Practice Address - Phone:956-984-6163
Practice Address - Fax:956-943-5161
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15936235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist