Provider Demographics
NPI:1174294623
Name:HUNSUCKER, MIRANDA ADRIANNE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:ADRIANNE
Last Name:HUNSUCKER
Suffix:
Gender:F
Credentials:MS 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:PO BOX 499
Mailing Address - Street 2:
Mailing Address - City:SMYER
Mailing Address - State:TX
Mailing Address - Zip Code:79367-0499
Mailing Address - Country:US
Mailing Address - Phone:806-939-2507
Mailing Address - Fax:
Practice Address - Street 1:815 GRANT STREET
Practice Address - Street 2:
Practice Address - City:SMYER
Practice Address - State:TX
Practice Address - Zip Code:79367
Practice Address - Country:US
Practice Address - Phone:806-939-2507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118665235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist