Michael Susca, PH.D.

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

19994 Issued in CA

Practice address

3601 Pacific Ave
Stockton, CA 95211-0110

Phone

(209) 946-3232

Fax

(209) 946-2647

NPI assigned

Apr 13, 2014

Last updated

Apr 13, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1397347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397347200000",
    "number": "1578982005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4137 SUN RIVER CT",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952196565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 PACIFIC AVE",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952110110",
            "telephone_number": "209-946-3232",
            "fax_number": "209-946-2647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUSCA",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-04-13",
        "last_updated": "2014-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "19994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexis Surall
• Gerome Cornell Surrell III
• Jaylin Surrell
• Emilia Anna Surzyn, M.D.
• Mary Alice Susca
• Sara Allison Sutera
• Sutter Gould Medical Foundation (Stockton Medical Plaza Primary Care)
• Sutter Gould Medical Foundation (Stockton Surgery Center)
• Sutter Gould Medical Foundation (Stockton Medical Plaza Specialty Care)
• Sutter Gould Medical Foundation (Brookside Care Center)

• Speech-Language Pathologist in Stockton, CA
• Providers in Stockton, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.