Healthcare Provider Details

I. General information

NPI: 1174520381
Provider Name (Legal Business Name): H. ARTHUR FARNUM MA, CCC-SP
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/25/2007
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 Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: