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General NPI Number Information
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NPI Number | 1578982005
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Entity Type | Individual
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Provider Name | MICHAEL SUSCA PH.D.
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Gender | Male
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Dates
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Enumeration Date | 04/13/2014
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Last Update Date | 04/13/2014
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Provider Practice Location Address
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Address Line | 3601 PACIFIC AVE
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City | STOCKTON
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State | CA
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Zip | 95211-0110
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Country | US
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Telephone | 209-946-3232
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Fax | 209-946-2647
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Provider Business Mailing Address
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Address Line | 4137 SUN RIVER CT
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City | STOCKTON
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State | CA
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Zip | 95219-6565
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Country | US
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Telephone |
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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 | 19994
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License Number State | CA
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