Provider Demographics
NPI:1194722066
Name:GREEN MOUNTAIN SPEECH & HEARING SERVICES INC.
Entity type:Organization
Organization Name:GREEN MOUNTAIN SPEECH & HEARING SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FARNUM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-A
Authorized Official - Phone:802-223-6119
Mailing Address - Street 1:58 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-3043
Mailing Address - Country:US
Mailing Address - Phone:802-223-6119
Mailing Address - Fax:802-223-3054
Practice Address - Street 1:58 E STATE ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3043
Practice Address - Country:US
Practice Address - Phone:802-223-6119
Practice Address - Fax:802-223-3054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0007122Medicaid
VT7122OtherBC/BS
VT0007122Medicaid
VT0007122Medicaid