Basic Information
| Provider Information | |||||||||
| NPI: | 1366435240 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUHUMSKIE | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | ALLISON | ||||||||
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| Credential: | MA-CCC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1320 SUMMER LEE DR | ||||||||
| Address2: | |||||||||
| City: | ROCKWALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727715443 | ||||||||
| FaxNumber: | 9727715444 | ||||||||
| Practice Location | |||||||||
| Address1: | 1320 SUMMER LEE DR | ||||||||
| Address2: | |||||||||
| City: | ROCKWALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727715443 | ||||||||
| FaxNumber: | 9727715444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2005 | ||||||||
| LastUpdateDate: | 08/05/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 80079 | TX | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 900847004 | 01 | OR | BLUE CROSS BLUE SHIELD | OTHER | TXB142013 | 01 | TX | INDIVIDUAL PTAN | OTHER | 069067 | 05 | OR | MEDICAID | P00223552 | 01 | OR | RAIL ROAD MEDICARE | OTHER |