Provider Demographics
NPI:1285736827
Name:SIRAGUSA, SUSAN M (MSP,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:SIRAGUSA
Suffix:
Gender:F
Credentials:MSP,CCC-SLP
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:SIRAGUSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSP,CCC-SLP
Mailing Address - Street 1:5200 SUNNINGDALE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2675
Mailing Address - Country:US
Mailing Address - Phone:704-606-9137
Mailing Address - Fax:
Practice Address - Street 1:5200 SUNNINGDALE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2675
Practice Address - Country:US
Practice Address - Phone:704-606-9137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5246235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist