| Doctor Name: | MS. SUSANNE MARIE POULETTE |
| NPI Number: | 1538437603 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S. IN ED. |
| License Number: | 005341 |
| Business Practice Address: | 1239 Van Antwerp Rd Niskayuna, NY - 123095317 |
| Business Phone Number: | 5183774666 |
| Business Fax Number: | 5183774074 |
| Mailing Address: | 1239 Van Antwerp Rd, NISKAYUNA |
| State: | NY |
| Postal Code: | 123095317 |
| Phone Number: | 5183774666 |
| Fax Number: | 5183774074 |
| NPI Enumeration Date: | 12/05/2011 |
| NPI Last Update Date: | 12/05/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 005341 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |