MEDICARE: MS. SUSAN F. DERANJA 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 8241	CA

General Provider Information

NPI Number	:	1982634747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN F. DERANJA SLP

Provider Business Mailing Address
First Line	:	14618 TYLER FOOTE RD
Second Line	:
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-9316
Country	:	US
Telephone Number	:	530-478-7681
Fax Number	:

Provider Business Practice Location Address
First Line	:	14618 TYLER FOOTE RD
Second Line	:
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-9316
Country	:	US
Telephone Number	:	530-478-7681
Fax Number	:

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	09/12/2008

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