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General NPI Number Information
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NPI Number | 1265864672
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Entity Type | Individual
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Provider Name | SUSAN RISI M.A. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/07/2013
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Last Update Date | 08/07/2013
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Provider Practice Location Address
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Address Line | 24750 SWANSON RD
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City | SOUTHFIELD
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State | MI
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Zip | 48033-5320
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Country | US
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Telephone | 248-355-5800
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Fax | 248-355-5801
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Provider Business Mailing Address
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Address Line | 9104 WOODGROVE DR
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City | PLYMOUTH
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State | MI
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Zip | 48170-5748
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Country | US
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Telephone | 734-451-1425
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Fax |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7101001455
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License Number State | MI
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