MEDICARE: MRS. ALISSA SARA SUSKI M.A., 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	21041	CA

General Provider Information

NPI Number	:	1518381987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALISSA SARA SUSKI M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	28242 SHORE
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92692-4043
Country	:	US
Telephone Number	:	626-272-9449
Fax Number	:

Provider Business Practice Location Address
First Line	:	5151 MURPHY CANYON RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4440
Country	:	US
Telephone Number	:	626-272-9449
Fax Number	:

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

Provider Enumeration Date	:	02/05/2014
Last Update Date	:	04/08/2020

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Directions to “ MRS. ALISSA SARA SUSKI M.A., CCC-SLP” Practice Location

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