1942266820 NPI number — SUZANNE M. BARSLUND MS,CCC-SLP,ATP

Table of content: SUZANNE M. BARSLUND MS,CCC-SLP,ATP (NPI 1942266820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942266820 NPI number — SUZANNE M. BARSLUND MS,CCC-SLP,ATP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARSLUND
Provider First Name:
SUZANNE
Provider Middle Name:
M.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS,CCC-SLP,ATP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOMIAK
Provider Other First Name:
SUZANNE
Provider Other Middle Name:
M.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS,CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942266820
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
924 HERMOSA DR NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87110-7710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-463-3721
Provider Business Mailing Address Fax Number:
505-256-5705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 SAN PEDRO DR NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87110-6731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-265-1711
Provider Business Practice Location Address Fax Number:
505-256-5704
Provider Enumeration Date:
04/21/2006

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:  772 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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