Susan Mack, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

005876 Issued in NY

Practice address

15 Dovehill Cir
Penfield, NY 14526-1981

Phone

(585) 259-0772

NPI assigned

Apr 20, 2009

Last updated

Feb 18, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Susan Kwiatkowski Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1240185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455753600000",
    "number": "1669616793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 DOVEHILL CIR",
            "city": "PENFIELD",
            "state": "NY",
            "postal_code": "145261981",
            "telephone_number": "585-259-0772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 DOVEHILL CIR",
            "city": "PENFIELD",
            "state": "NY",
            "postal_code": "145261981",
            "telephone_number": "585-259-0772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "SUSAN",
        "name_prefix": "Ms.",
        "credential": "SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-04-20",
        "last_updated": "2016-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "005876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "KWIATKOWSKI",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Peter Lofurno, DMD
• James Edmund Lovelock, M.D.
• Stephanie Beth Lovett-Standish, OD, MBA
• Erin Dawn Lyon, LMSW, MA
• Stephanie M Macdonald, D.O.
• Melissa P Madonna
• Teresa Ann Magnotta, LMT
• Theresa J Maher, RN LMSW
• Elizabeth Makar-Piczko, RPA-C
• Stephanie Malone, OT

• Speech-Language Pathologist in Penfield, NY
• Providers in Penfield, NY by specialty
• Speech-Language Pathologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2016; 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.