1134570658 NPI number — SUSAN ELIZABETH VERNER M.ED., CCC-SLP

Table of content: SUSAN ELIZABETH VERNER M.ED., CCC-SLP (NPI 1134570658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134570658 NPI number — SUSAN ELIZABETH VERNER M.ED., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VERNER
Provider First Name:
SUSAN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHEPPARD
Provider Other First Name:
SUSAN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED., CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134570658
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1560 HENTHORNE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAUMEE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43537-1371
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-665-1968
Provider Business Mailing Address Fax Number:
419-866-5663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1560 HENTHORNE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAUMEE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43537-1371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-866-5196
Provider Business Practice Location Address Fax Number:
419-866-5663
Provider Enumeration Date:
06/27/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SP.3296 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0392980 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1609899061 . This is a "COMPANY NPI" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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