MEDICARE: MRS. SUSANA S HAN MA, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP16511	CA

General Provider Information

NPI Number	:	1184913352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSANA S HAN MA, CCC-SLP

Provider Business Mailing Address
First Line	:	2713 RIO LEMPA DR
Second Line	:
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-5506
Country	:	US
Telephone Number	:	626-848-6643
Fax Number	:	626-961-8248

Provider Business Practice Location Address
First Line	:	2713 RIO LEMPA DR
Second Line	:
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-5506
Country	:	US
Telephone Number	:	626-848-6643
Fax Number	:	626-961-8248

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2011
Last Update Date	:	03/28/2011

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