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General NPI Number Information
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NPI Number | 1669564282
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Entity Type | Individual
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Provider Name | SUSANNAH C DOHERTY SLP
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Gender | Female
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12276 SAN JOSE BLVD. SUITE 508
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City | JACKSONVILLE
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State | FL
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Zip | 32223-8628
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Country | US
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Telephone | 904-886-3228
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Fax |
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Provider Business Mailing Address
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Address Line | 1538 CHARON RD
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City | JACKSONVILLE
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State | FL
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Zip | 32205-9202
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Country | US
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Telephone | 904-387-0986
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Fax | 904-388-6235
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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 | SA3951
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License Number State | FL
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