Provider Demographics
NPI:1245437268
Name:ADAMS, SUSAN KAYE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAYE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:KAYE
Other - Last Name:SIBERT/SAMPLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:25065 SANBORN RD
Mailing Address - Street 2:
Mailing Address - City:CALHAN
Mailing Address - State:CO
Mailing Address - Zip Code:80808-8510
Mailing Address - Country:US
Mailing Address - Phone:308-390-2594
Mailing Address - Fax:
Practice Address - Street 1:25065 SANBORN RD
Practice Address - Street 2:
Practice Address - City:CALHAN
Practice Address - State:CO
Practice Address - Zip Code:80808-8510
Practice Address - Country:US
Practice Address - Phone:308-390-2594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NE1229235Z00000X
CO0001670235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47065477700Medicaid
CO47065477700Medicaid