Individual
MRS. SUZANNE TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
STILLWELL ROAD, ROUTE 1, MARLINTON, WV 24954-9801
(304) 799-7375
(304) 799-7378
Mailing address
PO BOX 162, SLATYFORK, WV 26291-0162
(304) 572-1178
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
0401
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0004082000
—
WV
Enumeration date
04/17/2007
Last updated
07/08/2007
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