Provider Demographics
NPI:1376757278
Name:BUNTING, SUSAN (MA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BUNTING
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 771
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603
Mailing Address - Country:US
Mailing Address - Phone:907-235-2381
Mailing Address - Fax:907-235-0552
Practice Address - Street 1:1060 E END RD
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7205
Practice Address - Country:US
Practice Address - Phone:907-399-2381
Practice Address - Fax:907-235-0552
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2231H00000X
AK22235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKAU0174Medicaid
AKSP01741Medicaid
AK160632Medicare ID - Type UnspecifiedSPEECH-LANGUAGE PATH
AKAU0174Medicaid