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NPI Code Detail

MEDICARE: SUSAN JANE STAUBER SLP

MEDICARE: SUSAN JANE STAUBER 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
1235Z00000XSpeech-Language Pathologist011001-1NY

General Provider Information

NPI Number : 1760764237
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN JANE STAUBER SLP
Provider Business Mailing Address
First Line : 750 MAIDEN LN
Second Line :
City : ROCHESTER
State : NY
Zip : 14615-1230
Country : US
Telephone Number : 585-966-1000
Fax Number :
Provider Business Practice Location Address
First Line : 750 MAIDEN LN
Second Line :
City : ROCHESTER
State : NY
Zip : 14615-1230
Country : US
Telephone Number : 585-966-5200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2011
Last Update Date : 01/22/2013

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Directions to “ SUSAN JANE STAUBER SLP” Practice Location

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