Active NPI
Susanna Ritacca Fishlove, CCC-SLP
- Speech-Language Pathologist
- Shoreview, MN
National Provider Identifier
1720617418
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 10285
- Practice address
- 535 Lake Summit CT
Shoreview, MN 55126-4010 - Phone
- (954) 707-0829
- NPI assigned
- Apr 3, 2020
- Sex
- Female
- Sole proprietor
- No
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 | 10285 | MN | Primary |
Addresses
Primary practice location
535 Lake Summit CT
Shoreview, MN 55126-4010
Mailing address
535 Lake Summit CT
Shoreview, MN 55126-4010
Phone (612) 368-7474
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10285 | MN | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592870400000",
"number": "1720617418",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "535 LAKE SUMMIT CT",
"city": "SHOREVIEW",
"state": "MN",
"postal_code": "551264010",
"telephone_number": "612-368-7474"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "535 LAKE SUMMIT CT",
"city": "SHOREVIEW",
"state": "MN",
"postal_code": "551264010",
"telephone_number": "954-707-0829"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FISHLOVE",
"first_name": "SUSANNA",
"middle_name": "RITACCA",
"credential": "CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-04-03",
"last_updated": "2020-06-23",
"certification_date": "2020-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MN",
"license": "10285",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shoreview, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.