Provider Demographics
NPI:1578717591
Name:BLANCHARD, SUSAN WHITE (SLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:WHITE
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-1576
Mailing Address - Country:US
Mailing Address - Phone:607-739-0491
Mailing Address - Fax:
Practice Address - Street 1:287 SCENIC DR
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-1576
Practice Address - Country:US
Practice Address - Phone:607-739-0491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011300 1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist