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General NPI Number Information
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NPI Number | 1205007754
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Entity Type | Individual
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Provider Name | SUSAN WENICK INDEN M.A.
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Gender | Female
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Dates
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Enumeration Date | 03/12/2008
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Last Update Date | 03/12/2008
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Provider Practice Location Address
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Address Line | 8020 CASTOR AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19152-2732
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Country | US
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Telephone | 215-722-4111
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Fax | 215-722-3163
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Provider Business Mailing Address
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Address Line | 8020 CASTOR AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19152-2732
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Country | US
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Telephone | 215-722-4111
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Fax | 215-722-3163
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231HA2500X
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Taxonomy Name | Assistive Technology Supplier Audiologist
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License Number | AT000406L
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License Number State | PA
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