Healthcare Provider Details

I. General information

NPI: 1194722066
Provider Name (Legal Business Name): GREEN MOUNTAIN SPEECH & HEARING SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 E STATE ST
MONTPELIER VT
05602-3043
US

IV. Provider business mailing address

58 E STATE ST
MONTPELIER VT
05602-3043
US

V. Phone/Fax

Practice location:
  • Phone: 802-223-6119
  • Fax: 802-223-3054
Mailing address:
  • Phone: 802-223-6119
  • Fax: 802-223-3054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateVT

VIII. Authorized Official

Name: SANDRA D FARNUM
Title or Position: PRESIDENT / AUDIOLOGIST
Credential: MS, CCC-A
Phone: 802-223-6119