Doctor Name: | DR. MICHAEL SUSCA |
NPI Number: | 1578982005 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | 19994 |
Business Practice Address: | 3601 Pacific Ave Stockton, CA - 952110110 |
Business Phone Number: | 2099463232 |
Business Fax Number: | 2099462647 |
Mailing Address: | 4137 Sun River Ct, STOCKTON |
State: | CA |
Postal Code: | 952196565 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/13/2014 |
NPI Last Update Date: | 04/13/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 19994 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
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 |