Provider Demographics
NPI:1790013662
Name:HUNTER, SUE B (MS, ED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:B
Last Name:HUNTER
Suffix:
Gender:F
Credentials:MS, ED, CCC-SLP
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 69030
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9030
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:1580 ARMORY DR STE B
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-2470
Practice Address - Country:US
Practice Address - Phone:757-562-0990
Practice Address - Fax:757-562-0496
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202001350235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1790013662Medicaid
VA1043237936Medicaid
VAC10066OtherMEDICARE PTAN
VAC10066OtherMEDICARE PTAN
VA1043237936Medicaid