MEDICARE: SUSAN A KHAN 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	NC1231	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13071	OTHER	NC	BCBSNC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720088669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN A KHAN MA, CCC-SLP

Provider Business Mailing Address
First Line	:	402 BERRYHILL DR
Second Line	:
City	:	CARRBORO
State	:	NC
Zip	:	27510-2431
Country	:	US
Telephone Number	:	919-968-2505
Fax Number	:

Provider Business Practice Location Address
First Line	:	1703 LEGION RD
Second Line	:	SUUITE 204
City	:	CHAPEL HILL
State	:	NC
Zip	:	27517-2359
Country	:	US
Telephone Number	:	919-932-7160
Fax Number	:

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	09/13/2007

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