Provider Demographics
NPI:1457337990
Name:UNIVERSITY AT BUFFALO SPEECH-LANGUAGE & HEARING CLINIC INC
Entity Type:Organization
Organization Name:UNIVERSITY AT BUFFALO SPEECH-LANGUAGE & HEARING CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR ASSOCIATE PROFESSOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN ANN
Authorized Official - Middle Name:T
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:716-829-2797
Mailing Address - Street 1:52 BIOMEDICAL EDUCATION BLDG
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-8016
Mailing Address - Country:US
Mailing Address - Phone:716-829-3980
Mailing Address - Fax:716-829-3974
Practice Address - Street 1:52 BIOMEDICAL EDUCATION BLDG
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-8016
Practice Address - Country:US
Practice Address - Phone:716-829-3980
Practice Address - Fax:716-829-3974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1500001003261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
9210117OtherINDEPENDENT HEALTH
00011240404OtherUNIVERA
=========OtherNORTH AMERICAN PREFERRED
9210117OtherINDEPENDENT HEALTH
00011240404OtherUNIVERA
AA1308Medicare ID - Type Unspecified