Provider Demographics
NPI:1902623044
Name:SU, STEPHEN (MS, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:SU
Suffix:
Gender:
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 1:2-1-4-306 FUJIWARADAI KITAMACHI, KITA-JU
Mailing Address - Street 2:
Mailing Address - City:KOBE
Mailing Address - State:HYOGO
Mailing Address - Zip Code:6511301
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2-1-4-306 FUJIWARADAI KITAMACHI, KITA-KU
Practice Address - Street 2:
Practice Address - City:KOBE
Practice Address - State:HYOGO
Practice Address - Zip Code:6511301
Practice Address - Country:JP
Practice Address - Phone:626-788-2669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10394235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist