MEDICARE: SUSAN BAUER 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	SA6822	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S2727	OTHER	FL	PROVIDER NUMBER

General Provider Information

NPI Number	:	1588796619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN BAUER CCC-SLP

Provider Business Mailing Address
First Line	:	5421 SW COUNTY ROAD 240
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32024-1774
Country	:	US
Telephone Number	:	386-867-3706
Fax Number	:	385-867-3706

Provider Business Practice Location Address
First Line	:	5421 SW COUNTY ROAD 240
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32024-1774
Country	:	US
Telephone Number	:	386-867-3706
Fax Number	:

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	12/23/2024

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Directions to “ SUSAN BAUER CCC-SLP” Practice Location

Language	Start Address	Practice Location

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