Provider Demographics
NPI:1588995823
Name:FIELDS, SUSAN TANSEY (SLP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:TANSEY
Last Name:FIELDS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:KATHLEEN
Other - Last Name:TANSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:345 WILLIAMSON PL
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1515
Mailing Address - Country:US
Mailing Address - Phone:361-694-4391
Mailing Address - Fax:361-694-4821
Practice Address - Street 1:3533 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1721
Practice Address - Country:US
Practice Address - Phone:361-694-4391
Practice Address - Fax:361-694-4821
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15304235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist