=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891930616
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN BETH MUNZ CCC/SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2008
-----------------------------------------------------
Last Update Date | 12/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21302 75TH AVE APT. 4F
-----------------------------------------------------
City | OAKLAND GARDENS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11364-3364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-691-4931
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21302 75TH AVE APT. 4F
-----------------------------------------------------
City | OAKLAND GARDENS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11364-3364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-691-4931
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 011202
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------