Provider Demographics
NPI:1073723342
Name:SANAGORSKI-PHILLIPS, SUSAN BETH (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:BETH
Last Name:SANAGORSKI-PHILLIPS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BAILEY BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HARMONY
Mailing Address - State:ME
Mailing Address - Zip Code:04942-7233
Mailing Address - Country:US
Mailing Address - Phone:207-683-2027
Mailing Address - Fax:
Practice Address - Street 1:29 BAILEY BRIDGE RD
Practice Address - Street 2:
Practice Address - City:HARMONY
Practice Address - State:ME
Practice Address - Zip Code:04942-7233
Practice Address - Country:US
Practice Address - Phone:207-683-2027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP368235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11547334OtherCAQH