Provider Demographics
NPI:1699257352
Name:CLEMENTS, SUZANNE LOUISE (SLPA)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:LOUISE
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:MS
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:SOLORZANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5590 BAJA DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-2235
Mailing Address - Country:US
Mailing Address - Phone:619-204-8486
Mailing Address - Fax:
Practice Address - Street 1:9466 BLACK MOUNTAIN RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4550
Practice Address - Country:US
Practice Address - Phone:858-689-2027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17482355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant