Provider Demographics
NPI:1316085095
Name:CESSAN, SUSAN E (MS,CCC,LP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:E
Last Name:CESSAN
Suffix:
Gender:F
Credentials:MS,CCC,LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-9788
Mailing Address - Country:US
Mailing Address - Phone:307-332-4235
Mailing Address - Fax:
Practice Address - Street 1:59 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-9788
Practice Address - Country:US
Practice Address - Phone:307-332-4235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP#134235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist