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NPI Code Detail

MEDICARE: SUSAN PURVIANCE MSED, CCC-SLP

MEDICARE: SUSAN PURVIANCE MSED, 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
1235Z00000XSpeech-Language Pathologist9156SC
2235Z00000XSpeech-Language Pathologist13215NC
3235Z00000XSpeech-Language Pathologist015604-1NY

General Provider Information

NPI Number : 1245548528
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN PURVIANCE MSED, CCC-SLP
Provider Business Mailing Address
First Line : 105 WAXHAW PROFESSIONAL PARK DR STE A
Second Line :
City : WAXHAW
State : NC
Zip : 28173-5018
Country : US
Telephone Number : 704-627-4027
Fax Number : 704-684-4644
Provider Business Practice Location Address
First Line : 105 WAXHAW PROFESSIONAL PARK DR STE A
Second Line :
City : WAXHAW
State : NC
Zip : 28173-5018
Country : US
Telephone Number : 704-627-4027
Fax Number : 704-684-4644
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2010
Last Update Date : 03/19/2025

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Directions to “ SUSAN PURVIANCE MSED, CCC-SLP” Practice Location

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