Healthcare Provider Details

I. General information

NPI: 1396746814
Provider Name (Legal Business Name): SUSAN G KASUNICK M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18660 BAGLEY RD SUITE 404
CLEVELAND OH
44130-3480
US

IV. Provider business mailing address

PO BOX 567
CHAGRIN FALLS OH
44022-0567
US

V. Phone/Fax

Practice location:
  • Phone: 440-243-3600
  • Fax:
Mailing address:
  • Phone: 216-464-5160
  • Fax: 216-464-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA00578
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: