Healthcare Provider Details

I. General information

NPI: 1114923638
Provider Name (Legal Business Name): SUSAN BARTLETT MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 BOLTON RD # U-85
STORRS MANSFIELD CT
06269-9020
US

IV. Provider business mailing address

65 KANE ST PROVIDER ENROLLMENT-ELLIE ATKINS
WEST HARTFORD CT
06119-2110
US

V. Phone/Fax

Practice location:
  • Phone: 860-486-2629
  • Fax: 860-486-5422
Mailing address:
  • Phone: 860-523-6421
  • Fax: 860-523-3701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number000626
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: