Provider Demographics
NPI:1316112519
Name:LAROCCA, SUZAN L (MS-SLP/CCC)
Entity type:Individual
Prefix:MRS
First Name:SUZAN
Middle Name:L
Last Name:LAROCCA
Suffix:
Gender:F
Credentials:MS-SLP/CCC
Other - Prefix:
Other - First Name:SUZAN
Other - Middle Name:L
Other - Last Name:MCKENNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS-SLP/CCC
Mailing Address - Street 1:4310 METRO PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-9416
Mailing Address - Country:US
Mailing Address - Phone:833-362-7935
Mailing Address - Fax:
Practice Address - Street 1:4310 METRO PKWY STE 205
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-9416
Practice Address - Country:US
Practice Address - Phone:833-362-7935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12777235Z00000X
MA7357235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12111287OtherASHA CERTIFICATE OF CLINICAL COMPETENCE