Provider Demographics
NPI:1689636318
Name:HANSBOROUGH, SUSAN J (AUDIOLOGIST)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:HANSBOROUGH
Suffix:
Gender:F
Credentials:AUDIOLOGIST
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 1500, BOX W-1
Mailing Address - Street 2:CREDENTIALING
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939
Mailing Address - Country:US
Mailing Address - Phone:540-332-7087
Mailing Address - Fax:
Practice Address - Street 1:243 WOODROW WILSON AVE
Practice Address - Street 2:CREDENTIALING
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939
Practice Address - Country:US
Practice Address - Phone:540-332-7087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201000144231H00000X
VA2101000806237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004980107Medicaid
VA009451528Medicaid
VA009451528Medicaid