Provider Demographics
NPI:1124232301
Name:BERGEY, SUSAN B (CCC SLP L)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
Last Name:BERGEY
Suffix:
Gender:F
Credentials:CCC SLP L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 HAMILTON DR
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-2150
Mailing Address - Country:US
Mailing Address - Phone:215-513-0901
Mailing Address - Fax:
Practice Address - Street 1:310 BROAD ST
Practice Address - Street 2:SUITE H
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-2399
Practice Address - Country:US
Practice Address - Phone:215-513-2240
Practice Address - Fax:215-513-1891
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL006179L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist