Provider Demographics
NPI:1528343522
Name:RUSSELL, SUZANNE K (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:K
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3456 COUNTY ROAD 16
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-2443
Mailing Address - Country:US
Mailing Address - Phone:905-585-0610
Mailing Address - Fax:
Practice Address - Street 1:1490 STATE ROUTE 488
Practice Address - Street 2:
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432-9308
Practice Address - Country:US
Practice Address - Phone:315-548-6420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12112499235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist