Provider Demographics
NPI:1427118199
Name:ALTSTAETTER, SUZANNE BONIFERT (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:BONIFERT
Last Name:ALTSTAETTER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:BONIFERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:2407 ARAMIC CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-8124
Mailing Address - Country:US
Mailing Address - Phone:817-472-6620
Mailing Address - Fax:
Practice Address - Street 1:1966 INWOOD RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7205
Practice Address - Country:US
Practice Address - Phone:214-905-3129
Practice Address - Fax:214-905-3016
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17130235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist