Provider Demographics
NPI:1194795096
Name:WINDMILL, SUE M (AU D)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:M
Last Name:WINDMILL
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:DEPARTMENT OF OTOLARYNGOLOGY
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5160
Mailing Address - Fax:601-815-6985
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:DEPARTMENT OF OTOLARYNGOLOGY
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5160
Practice Address - Fax:601-815-6985
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0161231H00000X
MS3325231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200256380AMedicaid
KY50000009OtherKY MEDICAID HEARING AID
KY70000112Medicaid
AL155478Medicaid
KY1115678OtherPASSPORT
MS06631761Medicaid
IN200256380AMedicaid
AL155478Medicaid
KY1275096Medicare PIN