1073641791 NPI number — MRS. SUSAN MICHELLE OSBORNE MS,CCC-SLP

Table of content: MRS. SUSAN MICHELLE OSBORNE MS,CCC-SLP (NPI 1073641791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073641791 NPI number — MRS. SUSAN MICHELLE OSBORNE MS,CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSBORNE
Provider First Name:
SUSAN
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS,CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073641791
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3120 MIDWAY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURRAY
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42071-6922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-492-8519
Provider Business Mailing Address Fax Number:
270-492-8519

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3120 MIDWAY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42071-6922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-492-8519
Provider Business Practice Location Address Fax Number:
270-492-8519
Provider Enumeration Date:
03/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  KY-2390 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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