Provider Demographics
NPI:1205034535
Name:SUE PANGER & ASSOCIATES, SC
Entity Type:Organization
Organization Name:SUE PANGER & ASSOCIATES, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PANGER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:262-652-9599
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53141-0096
Mailing Address - Country:US
Mailing Address - Phone:262-652-9599
Mailing Address - Fax:
Practice Address - Street 1:811 60TH ST
Practice Address - Street 2:2E
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-4074
Practice Address - Country:US
Practice Address - Phone:262-652-9599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-09
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)