Provider Demographics
NPI:1134463433
Name:SOUTHARD, MARGARET L (SP ED)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:L
Last Name:SOUTHARD
Suffix:
Gender:F
Credentials:SP ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 INTREPID LN
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-2548
Mailing Address - Country:US
Mailing Address - Phone:315-437-4698
Mailing Address - Fax:315-437-4689
Practice Address - Street 1:5962 RT 31
Practice Address - Street 2:SUITE 7 BOX 10
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039
Practice Address - Country:US
Practice Address - Phone:315-698-0033
Practice Address - Fax:315-698-0031
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1104109016OtherORGANIZATION NPI