Basic Information
| Provider Information | |||||||||
| NPI: | 1689930422 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIDSMEYER-BULLINGER | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4560 SW INTERNATIONAL WAY | ||||||||
| Address2: | STE. 100 | ||||||||
| City: | MILWAUKIE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712065200 | ||||||||
| FaxNumber: | 9712065203 | ||||||||
| Practice Location | |||||||||
| Address1: | 2332 LIBERTY DR. | ||||||||
| Address2: | |||||||||
| City: | CORALVILLE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 52241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3195457390 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2012 | ||||||||
| LastUpdateDate: | 04/05/2012 | ||||||||
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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 | 235Z00000X | 01299 | IA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.