Provider Demographics
NPI:1972728384
Name:MUNDT, SUSAN S (MA, CCC-SP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:S
Last Name:MUNDT
Suffix:
Gender:F
Credentials:MA, CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 STONY LANE CIR
Mailing Address - Street 2:
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976-1031
Mailing Address - Country:US
Mailing Address - Phone:215-918-0598
Mailing Address - Fax:
Practice Address - Street 1:96 STONY LANE CIR
Practice Address - Street 2:
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-1031
Practice Address - Country:US
Practice Address - Phone:215-918-0598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL002586L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist