Provider Demographics
NPI:1912199308
Name:GIBBONS, SUSAN MUMBY (AUD, CCC-A/SLP)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MUMBY
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:AUD, CCC-A/SLP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:A
Other - Last Name:MUMBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-A/SPL
Mailing Address - Street 1:243 CHARLES ST
Mailing Address - Street 2:DEPARTMENT OF AUDIOLOGY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3002
Mailing Address - Country:US
Mailing Address - Phone:617-573-3266
Mailing Address - Fax:617-573-3023
Practice Address - Street 1:243 CHARLES ST
Practice Address - Street 2:DEPARTMENT OF AUDIOLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3002
Practice Address - Country:US
Practice Address - Phone:617-573-3266
Practice Address - Fax:617-573-3023
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA870231H00000X
MA7170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist