Provider Demographics
NPI:1013182724
Name:HAMRE, SUSAN DEAN (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DEAN
Last Name:HAMRE
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3731 STATE HIGHWAY 14
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8056
Mailing Address - Country:US
Mailing Address - Phone:505-470-3422
Mailing Address - Fax:505-214-5140
Practice Address - Street 1:3731 STATE HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-8056
Practice Address - Country:US
Practice Address - Phone:505-470-3422
Practice Address - Fax:505-214-5140
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM538235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist