Provider Demographics
NPI:1366288193
Name:BATEMAN, SUSAN BLAIR (VA SLP LIC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:BLAIR
Last Name:BATEMAN
Suffix:
Gender:F
Credentials:VA SLP LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KIDS CARE HOME HEALTH CARE
Mailing Address - Street 2:14651 DALLAS PARKWAY SUITE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254
Mailing Address - Country:US
Mailing Address - Phone:866-919-3240
Mailing Address - Fax:
Practice Address - Street 1:KIDS CARE HOME HEALTH CARE
Practice Address - Street 2:14651 DALLAS PARKWAY SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254
Practice Address - Country:US
Practice Address - Phone:866-919-3240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007708235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist