Individual
MRS. SUSAN M BASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MCD-CCC-SLP
Contact information
Practice address
112 CHESTNUT ST, THAYER, MO 65791-1202
(573) 996-3046
(573) 996-3046
Mailing address
112 CHESTNUT ST., THAYER, MO 65791
(573) 996-3046
(573) 996-3046
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
111929
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
467718219
—
MO
Enumeration date
01/22/2007
Last updated
09/15/2012
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