Provider Demographics
NPI:1699941278
Name:IGDALSKY, SUZANNE R (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:R
Last Name:IGDALSKY
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 AL UNSER ROAD
Mailing Address - Street 2:P.O. BOX # 41
Mailing Address - City:LONG POND
Mailing Address - State:PA
Mailing Address - Zip Code:18334-0041
Mailing Address - Country:US
Mailing Address - Phone:570-656-2062
Mailing Address - Fax:570-643-2867
Practice Address - Street 1:1510 AL UNSER ROAD
Practice Address - Street 2:
Practice Address - City:LONG POND
Practice Address - State:PA
Practice Address - Zip Code:18334-0041
Practice Address - Country:US
Practice Address - Phone:570-656-2062
Practice Address - Fax:570-643-2867
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL006188L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist