Provider Demographics
NPI:1447432802
Name:TAULIA, SUSAN M (AUD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:TAULIA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:MOORE
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:823 PARK EAST BLVD # H
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-0787
Mailing Address - Country:US
Mailing Address - Phone:765-448-6226
Mailing Address - Fax:765-448-9416
Practice Address - Street 1:823 PARK EAST BLVD # H
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-0787
Practice Address - Country:US
Practice Address - Phone:765-448-6226
Practice Address - Fax:765-448-9416
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002417A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
M400015604Medicare PIN