Basic Information
| Provider Information | |||||||||
| NPI: | 1164501854 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENOCHS | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | PARK | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1380 FRIZZELL RD | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383516844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7312349200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 524 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | DECATURVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383298101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7318523591 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.