Provider Demographics
NPI:1154463586
Name:BERSUCH, HEATHER DENEANE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DENEANE
Last Name:BERSUCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:DENEANE
Other - Last Name:PRANGLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:313 SE GINGERBREAD LN
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-3612
Mailing Address - Country:US
Mailing Address - Phone:816-229-6228
Mailing Address - Fax:
Practice Address - Street 1:2133 NW 13TH ST
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-7734
Practice Address - Country:US
Practice Address - Phone:816-224-0003
Practice Address - Fax:816-224-2199
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000163575235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist