MEDICARE: SUSAN CLEMONS-PERAGINE MS, 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	SP-1556	NV

General Provider Information

NPI Number	:	1437571239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN CLEMONS-PERAGINE MS, CCC-SLP

Provider Business Mailing Address
First Line	:	5021 CAMINO LIBRE ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2400
Country	:	US
Telephone Number	:	828-335-9088
Fax Number	:

Provider Business Practice Location Address
First Line	:	5021 CAMINO LIBRE ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2400
Country	:	US
Telephone Number	:	828-335-9088
Fax Number	:

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

Provider Enumeration Date	:	01/13/2014
Last Update Date	:	10/07/2014

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Directions to “ SUSAN CLEMONS-PERAGINE MS, CCC-SLP” Practice Location

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