Provider Demographics
NPI:1992940027
Name:MCGINNIS, SUSAN H (SLP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:H
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13254 PECKY CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-5085
Mailing Address - Country:US
Mailing Address - Phone:904-260-1590
Mailing Address - Fax:
Practice Address - Street 1:13254 PECKY CYPRESS DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-5085
Practice Address - Country:US
Practice Address - Phone:904-260-1590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6912235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist