Provider Demographics
NPI:1043531585
Name:CALLAWAY, SUSANNA LOVE (AUD, CCC-A)
Entity type:Individual
Prefix:DR
First Name:SUSANNA
Middle Name:LOVE
Last Name:CALLAWAY
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3029 WINESAP DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-3155
Mailing Address - Country:US
Mailing Address - Phone:616-249-8000
Mailing Address - Fax:616-249-8088
Practice Address - Street 1:1555 44TH ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-4395
Practice Address - Country:US
Practice Address - Phone:616-249-8000
Practice Address - Fax:616-249-8088
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000553231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist