Doctor Name: | SUSAN MARDJETKO |
NPI Number: | 1659688869 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | SA2502 |
Business Practice Address: | 7927 State Road 52 Atria Baypoint Village Hudson, FL - 34667 |
Business Phone Number: | 7273788586 |
Business Fax Number: | 7273788587 |
Mailing Address: | 7927 State Road 52, HUDSON |
State: | FL |
Postal Code: | 34667 |
Phone Number: | 7273788586 |
Fax Number: | 7273788587 |
NPI Enumeration Date: | 09/09/2010 |
NPI Last Update Date: | 10/01/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SA2502 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
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 |