Provider Demographics
NPI:1215124060
Name:DAUGHERTY, SUSAN HOWLETT (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:HOWLETT
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12555 BISCAYNE BLVD
Mailing Address - Street 2:#836
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2522
Mailing Address - Country:US
Mailing Address - Phone:305-892-8706
Mailing Address - Fax:
Practice Address - Street 1:12555 BISCAYNE BLVD
Practice Address - Street 2:#836
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2522
Practice Address - Country:US
Practice Address - Phone:305-892-8706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7956235Z00000X
NY015982-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist