Provider Demographics
NPI:1588793640
Name:LAMAR, SUSAN LOUISE (MA-ST)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LOUISE
Last Name:LAMAR
Suffix:
Gender:F
Credentials:MA-ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4767 TURNER RD
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:NY
Mailing Address - Zip Code:14462-9516
Mailing Address - Country:US
Mailing Address - Phone:585-789-0898
Mailing Address - Fax:
Practice Address - Street 1:4767 TURNER RD
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:NY
Practice Address - Zip Code:14462-9516
Practice Address - Country:US
Practice Address - Phone:585-789-0898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0200481235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist