Individual
SUSAN O CARNEOL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
10303 N PORT WASHINGTON RD STE 203, NORTH SHORE CENTER LLC, MEQUON, WI 53092-5760
(262) 241-5955
(262) 241-5926
Mailing address
10303 N PORT WASHINGTON RD STE 203, NORTH SHORE CENTER, LLC, MEQUON, WI 53092-5760
(262) 241-5955
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
448154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42555000
—
WI
Enumeration date
11/16/2006
Last updated
12/10/2009
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