MEDICARE: SUSAN DOHERTY MA, 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

General Provider Information

NPI Number	:	1851982748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN DOHERTY MA, CCC-SLP

Provider Business Mailing Address
First Line	:	8758 E 24TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-2921
Country	:	US
Telephone Number	:	303-324-5435
Fax Number	:

Provider Business Practice Location Address
First Line	:	8758 E 24TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-2921
Country	:	US
Telephone Number	:	303-324-5435
Fax Number	:

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

Provider Enumeration Date	:	02/02/2021
Last Update Date	:	09/08/2023

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Directions to “ SUSAN DOHERTY MA, CCC-SLP” Practice Location

Language	Start Address	Practice Location

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