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NPI Code Detail

MEDICARE: SUSAN G. ALLEN SPEECH PATHOLOGIST

MEDICARE:   SUSAN G. ALLEN  SPEECH PATHOLOGIST
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
1235Z00000XSpeech-Language PathologistSA3208FL

General Provider Information

NPI Number : 1205031523
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN G. ALLEN SPEECH PATHOLOGIST
Provider Business Mailing Address
First Line : 2887 EVERCHARM PL
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32257-5865
Country : US
Telephone Number : 904-268-3225
Fax Number :
Provider Business Practice Location Address
First Line : 9857 SAINT AUGUSTINE RD
Second Line : SUITE 6
City : JACKSONVILLE
State : FL
Zip : 32257-8853
Country : US
Telephone Number : 904-880-9001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2007
Last Update Date : 07/08/2007

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Directions to “ SUSAN G. ALLEN SPEECH PATHOLOGIST” Practice Location

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