MEDICARE: SUSANNAH AMISS M.S.CCC-SLP

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	102717	TX

General Provider Information

NPI Number	:	1205075355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANNAH AMISS M.S.CCC-SLP

Provider Business Mailing Address
First Line	:	12710 RESEARCH BLVD STE 395
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-4397
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5816 WILCAB RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78721-2805
Country	:	US
Telephone Number	:	512-822-4350
Fax Number	:

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

Provider Enumeration Date	:	02/12/2009
Last Update Date	:	12/02/2022

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Directions to “ SUSANNAH AMISS M.S.CCC-SLP” Practice Location

Language	Start Address	Practice Location

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