Provider Demographics
NPI:1871771741
Name:DAVIS, SUSAN HART (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:HART
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:HART
Other - Last Name:HUBBARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:23 CORLISS FARM RD
Mailing Address - City:BROWNSVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05037
Mailing Address - Country:US
Mailing Address - Phone:802-484-7294
Mailing Address - Fax:
Practice Address - Street 1:8 GILL TERRACE
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:VT
Practice Address - Zip Code:05149
Practice Address - Country:US
Practice Address - Phone:802-228-4571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist