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General NPI Number Information
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NPI Number | 1699832741
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Entity Type | Individual
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Provider Name | SUZANNE RENEE HALSTEAD M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 01/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 986 BELVEDERE DR
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City | LEBANON
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State | OH
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Zip | 45036-2890
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Country | US
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Telephone | 513-934-1226
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Fax |
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Provider Business Mailing Address
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Address Line | 5523 WOODMANSEE WAY
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City | LIBERTY TWP
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State | OH
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Zip | 45011-5913
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Country | US
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Telephone | 513-777-9244
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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 | SP 6151
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License Number State | OH
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