Provider Demographics
NPI:1588728521
Name:GOOD, SUSAN BROWN (AUD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:BROWN
Last Name:GOOD
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ELAINE
Other - Last Name:GOOD
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:206 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-1604
Mailing Address - Country:US
Mailing Address - Phone:814-269-3315
Mailing Address - Fax:814-269-3319
Practice Address - Street 1:206 BELMONT ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-1604
Practice Address - Country:US
Practice Address - Phone:814-269-3315
Practice Address - Fax:814-269-3319
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT-000005-L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014961420001Medicaid
PABR594656OtherHIGHMARK BLUE SHIELD
PA0014961420001Medicaid