Provider Demographics
NPI:1366221400
Name:MCCONATHY, SUANNE MADDOX (MCD CCC-SLP)
Entity type:Individual
Prefix:
First Name:SUANNE
Middle Name:MADDOX
Last Name:MCCONATHY
Suffix:
Gender:F
Credentials:MCD CCC-SLP
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:SUANNE
Other - Last Name:MCCONATHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2416 BRISTOL CT
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-5560
Mailing Address - Country:US
Mailing Address - Phone:318-393-2043
Mailing Address - Fax:
Practice Address - Street 1:2500 VIKING DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2104
Practice Address - Country:US
Practice Address - Phone:318-549-6119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5021235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist