Provider Demographics
NPI:1487969556
Name:ABERNATHY, SUSAN MARIE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:ABERNATHY
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Gender:F
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:1 VILLAGE SQUARE CTR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-1817
Mailing Address - Country:US
Mailing Address - Phone:314-731-4555
Mailing Address - Fax:314-551-6110
Practice Address - Street 1:1 VILLAGE SQUARE CTR
Practice Address - Street 2:SUITE A
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1817
Practice Address - Country:US
Practice Address - Phone:314-731-4555
Practice Address - Fax:314-551-6110
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO104631235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist