Individual
SUSAN B MUNROE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
850 BOLTON RD, STORRS, CT 06269-9020
(860) 486-2629
(860) 486-5422
Mailing address
263 FARMINGTON AVE, PROVIDER ENROLLMENT, FARMINGTON, CT 06030-2212
(860) 679-7503
(860) 679-1610
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
001219
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4138807
—
CT
Enumeration date
06/28/2005
Last updated
06/28/2012
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