Healthcare Provider Details

I. General information

NPI: 1205168564
Provider Name (Legal Business Name): MRS. SUSAN FALZON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 CRATER CIR
LAKE HAVASU CITY AZ
86404-1441
US

IV. Provider business mailing address

1230 CRATER CIR
LAKE HAVASU CITY AZ
86404-1441
US

V. Phone/Fax

Practice location:
  • Phone: 928-453-2630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA6344
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: