Provider Demographics
NPI:1346543543
Name:DUMBACHER, SUSAN ASHWORTH (MS, CCC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ASHWORTH
Last Name:DUMBACHER
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:SUITE B-3
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2320
Mailing Address - Country:US
Mailing Address - Phone:770-831-2313
Mailing Address - Fax:770-831-2778
Practice Address - Street 1:1000 JOHNSON FERRY RD
Practice Address - Street 2:SUITE A100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2114
Practice Address - Country:US
Practice Address - Phone:770-977-9457
Practice Address - Fax:770-831-2313
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007397235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist