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General NPI Number Information
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NPI Number | 1427118199
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Entity Type | Individual
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Provider Name | SUZANNE BONIFERT ALTSTAETTER M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 09/28/2007
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Provider Practice Location Address
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Address Line | 1966 INWOOD RD
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City | DALLAS
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State | TX
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Zip | 75235-7205
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Country | US
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Telephone | 214-905-3129
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Fax | 214-905-3016
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Provider Business Mailing Address
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Address Line | 2407 ARAMIC CT
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City | ARLINGTON
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State | TX
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Zip | 76001-8124
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Country | US
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Telephone | 817-472-6620
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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 | 17130
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License Number State | TX
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