Provider Demographics
NPI:1376725838
Name:BARNARD, SUSAN KAY (MA CCCA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KAY
Last Name:BARNARD
Suffix:
Gender:F
Credentials:MA CCCA
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:KAY
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCCA
Mailing Address - Street 1:1450 FARR RD STE 5000
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-7789
Mailing Address - Country:US
Mailing Address - Phone:231-739-9095
Mailing Address - Fax:231-739-6439
Practice Address - Street 1:1450 FARR RD STE 5000
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-7789
Practice Address - Country:US
Practice Address - Phone:231-739-9095
Practice Address - Fax:231-739-6439
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000155231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI804678588Medicaid
MI902613459Medicaid