Provider Demographics
NPI:1013990357
Name:CARPENTER, SUSAN (CCC A)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:CCC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ROUTE 12 BLDG 449
Mailing Address - Street 2:NAVAL AMBULATORY CARE CENTER ATTN: PROFESSIONAL AFFAIRS
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06349-5600
Mailing Address - Country:US
Mailing Address - Phone:860-694-2377
Mailing Address - Fax:860-694-2590
Practice Address - Street 1:ROUTE 12 BLDG 449
Practice Address - Street 2:NAVAL AMBULATORY CARE CENTER ATTN: PROFESSIONAL AFFAIRS
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06349-5600
Practice Address - Country:US
Practice Address - Phone:860-694-2377
Practice Address - Fax:860-694-2590
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000261231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN