Provider Demographics
NPI:1346815057
Name:BULINGTON, SUSANNE MICHELLE
Entity Type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:MICHELLE
Last Name:BULINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 TIMBER RIDGE LN SE
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39653-7437
Mailing Address - Country:US
Mailing Address - Phone:601-996-0555
Mailing Address - Fax:
Practice Address - Street 1:93 TIMBER RIDGE LN SE
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:MS
Practice Address - Zip Code:39653-7437
Practice Address - Country:US
Practice Address - Phone:601-996-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS-4258235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist