Provider Demographics
NPI:1124350426
Name:STORM, SUSANNA (AUD)
Entity type:Individual
Prefix:DR
First Name:SUSANNA
Middle Name:
Last Name:STORM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 TELEGRAPH AVE
Mailing Address - Street 2:STE. 230
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705
Mailing Address - Country:US
Mailing Address - Phone:415-314-7272
Mailing Address - Fax:
Practice Address - Street 1:3017 TELEGRAPH AVE
Practice Address - Street 2:STE. 230
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705
Practice Address - Country:US
Practice Address - Phone:415-314-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007014895237600000X
CAAU-2766237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter