Individual
MRS. SUSAN EILEEN VAN WIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC/A
Contact information
Practice address
6425 W CONSTANCE WAY, LAVEEN, AZ 85339-2798
(602) 705-8705
Mailing address
6425 W CONSTANCE WAY, LAVEEN, AZ 85339-2798
(602) 705-8705
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
TAUD5402
AZ
235Z00000X
Speech-Language Pathologist
SLP4532
AZ
Other
Enumeration date
11/14/2007
Last updated
11/14/2007
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