Provider Demographics
NPI:1568040194
Name:BUNYARD, SUSAN GAILLARD (SLP-CCC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:GAILLARD
Last Name:BUNYARD
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 OAKHURST DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8192
Mailing Address - Country:US
Mailing Address - Phone:256-653-9907
Mailing Address - Fax:
Practice Address - Street 1:7200 GOVERNORS WEST NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-2051
Practice Address - Country:US
Practice Address - Phone:256-325-9905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist