MEDICARE: GREEN MOUNTAIN SPEECH & HEARING SERVICES INC.

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	231H00000X	Audiologist		VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	7122	OTHER	VT	BC/BS

General Provider Information

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

Provider Business Mailing Address
First Line	:	58 E STATE ST
Second Line	:
City	:	MONTPELIER
State	:	VT
Zip	:	05602-3043
Country	:	US
Telephone Number	:	802-223-6119
Fax Number	:	802-223-3054

Provider Business Practice Location Address
First Line	:	58 E STATE ST
Second Line	:
City	:	MONTPELIER
State	:	VT
Zip	:	05602-3043
Country	:	US
Telephone Number	:	802-223-6119
Fax Number	:	802-223-3054

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

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	07/21/2022

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