Provider Demographics
NPI:1104490457
Name:PIERRE, SUZANNE JUDITH-ANTONIA
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:JUDITH-ANTONIA
Last Name:PIERRE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SUZANNE
Other - Middle Name:JUDITH-ANTONIA
Other - Last Name:PIERRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:6586 HYPOLUXO RD # 202
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7678
Mailing Address - Country:US
Mailing Address - Phone:561-710-3040
Mailing Address - Fax:561-584-5370
Practice Address - Street 1:7258 SPINNAKER BAY DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-7669
Practice Address - Country:US
Practice Address - Phone:561-710-3040
Practice Address - Fax:561-584-5370
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA17007235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist