Provider Demographics
NPI:1215160254
Name:UPTON, SUSANNA (MED, CCC/SLP)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:
Last Name:UPTON
Suffix:
Gender:F
Credentials:MED, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 RHODE ISLAND ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-3215
Mailing Address - Country:US
Mailing Address - Phone:415-285-0645
Mailing Address - Fax:
Practice Address - Street 1:1046 RHODE ISLAND ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-3215
Practice Address - Country:US
Practice Address - Phone:415-285-0645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 12778235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist