MEDICARE: MRS. SUZANNE MARIE HARPER 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	1727 154	WI

General Provider Information

NPI Number	:	1922203389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUZANNE MARIE HARPER M.S. CCC SLP

Provider Business Mailing Address
First Line	:	6728 100TH AVE
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53142-7501
Country	:	US
Telephone Number	:	262-694-0496
Fax Number	:	262-694-0496

Provider Business Practice Location Address
First Line	:	1400 8TH AVE
Second Line	:
City	:	UNION GROVE
State	:	WI
Zip	:	53182-1063
Country	:	US
Telephone Number	:	262-878-5003
Fax Number	:

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

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	07/08/2007

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