MEDICARE: UNIVERSITY SSYTEM OF NEW HAMPSHIRE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1194929422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY SSYTEM OF NEW HAMPSHIRE

Provider Business Mailing Address
First Line	:	55 COLLEGE RD
Second Line	:	PETTEE HALL ROOM 103
City	:	DURHAM
State	:	NH
Zip	:	03824-2621
Country	:	US
Telephone Number	:	603-862-0561
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 LIBRARY WAY
Second Line	:	HEWITT HALL
City	:	DURHAM
State	:	NH
Zip	:	03824-3520
Country	:	US
Telephone Number	:	603-862-0561
Fax Number	:

Authorized Official
Title or Position	:	INTERDISCIPLINARY TRAINING DIRECTOR
Name	:	DR. RAE SONNENMEIER
Credential	:	PH.D., CCC-SLP
Telephone Number	:	603-862-0561

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	08/22/2020

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