Provider Demographics
NPI:1316506520
Name:STROCK, SUSAN MARIE (SLP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:STROCK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARIE
Other - Last Name:RICOTTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:2001 BISCAYNE BLVD
Mailing Address - Street 2:#3402
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-5018
Mailing Address - Country:US
Mailing Address - Phone:305-788-9054
Mailing Address - Fax:
Practice Address - Street 1:5190 NW 167TH ST STE 117
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6329
Practice Address - Country:US
Practice Address - Phone:305-517-3047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA16474235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA16474OtherHEALTHCARE LICENSE