MEDICARE: SUZETTE NIELSEN SLP-CCC, MCD,MED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	19612	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194846311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZETTE NIELSEN SLP-CCC, MCD,MED

Provider Business Mailing Address
First Line	:	P.O. BOX 1872
Second Line	:
City	:	MONTGOMERY
State	:	TX
Zip	:	77356-1872
Country	:	US
Telephone Number	:	936-827-6469
Fax Number	:

Provider Business Practice Location Address
First Line	:	981 ARBOR WAY
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77303
Country	:	US
Telephone Number	:	936-827-6469
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	09/02/2009

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