Active NPI
Susan Ruth Pollesel, MA CCC SP.
- Speech-Language Pathologist
- Ukiah, CA
National Provider Identifier
1104095314
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SP003652
- Practice address
- 793 S Dora St
Ukiah, CA 95482-5335 - Phone
- (707) 468-5193
- NPI assigned
- Feb 21, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SP003652 | CA | Primary |
Addresses
Primary practice location
793 S Dora St
Ukiah, CA 95482-5335
Mailing address
PO Box 1462
Ukiah, CA 95482-1462
Phone (707) 468-5193
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP003652 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203552000000",
"number": "1104095314",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1462",
"city": "UKIAH",
"state": "CA",
"postal_code": "954821462",
"telephone_number": "707-468-5193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "793 S DORA ST",
"city": "UKIAH",
"state": "CA",
"postal_code": "954825335",
"telephone_number": "707-468-5193"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLLESEL",
"first_name": "SUSAN",
"middle_name": "RUTH",
"name_prefix": "Mrs.",
"credential": "MA CCC SP.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-02-21",
"last_updated": "2008-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "SP003652",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ukiah, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.