Basic Information
| Provider Information | |||||||||
| NPI: | 1023294568 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARNES | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | JANE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MED CCC SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 47 OLD BARRE RD | ||||||||
| Address2: | |||||||||
| City: | PETERSHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787243538 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2033 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ATHOL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782493511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2008 | ||||||||
| LastUpdateDate: | 01/15/2008 | ||||||||
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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 | 3725 | MA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.