Provider Demographics
NPI:1598938102
Name:HART, SUSAN J (MCD,CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:J
Last Name:HART
Suffix:
Gender:
Credentials:MCD,CCC-SLP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:J
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MCD,CCC-SLP
Mailing Address - Street 1:1307 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-2272
Mailing Address - Country:US
Mailing Address - Phone:870-897-3724
Mailing Address - Fax:
Practice Address - Street 1:906 E MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3050
Practice Address - Country:US
Practice Address - Phone:870-897-3724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1430235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist