Susan M Bass, MCD-CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Thayer, MO
NPI 1881748358 · NPPES record last updated Sep 15, 2012
Key facts
- NPI
- 1881748358
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 111929 (MO)
- Practice address
- 112 Chestnut St
Thayer, MO 65791-1202 - Phone
- (573) 996-3046
- Fax
- (573) 996-3046
- NPI assigned
- Jan 22, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 111929 | MO | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 111929 | MO | Yes |
Addresses
Primary practice location
112 Chestnut St
Thayer, MO 65791-1202
Mailing address
112 Chestnut St.
Thayer, MO 65791
Phone (573) 996-3046
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 467718219 | Medicaid | MO |
Other providers in Thayer, MO
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- Janet Allen
- Brianna Alligood
- Holly Davis Baker
- Cambridge Adult Day Center-Thayer LLC
- Tyler Davis
- Diversified Consulting and Therapy Services PLLC
- Jacob Carl Eckman
- Fiorino Chiropractic Life Center
All providers in Thayer, MO · Speech-Language Pathologist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.