Provider Demographics
NPI:1285918367
Name:CHAMBERLAIN, SUE ANN
Entity type:Individual
Prefix:MS
First Name:SUE
Middle Name:ANN
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:CHAMBERLAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NBC-HIS
Mailing Address - Street 1:8151 RIVER ACRES RD
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-4566
Mailing Address - Country:US
Mailing Address - Phone:650-218-4088
Mailing Address - Fax:
Practice Address - Street 1:8617 W POINT DOUGLAS RD S STE 150
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-4161
Practice Address - Country:US
Practice Address - Phone:833-432-7483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2842237700000X
CA3389237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist