Provider Demographics
NPI:1215379227
Name:VONDERFECHT, SUSAN MARIE (AUD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:VONDERFECHT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARIE
Other - Last Name:STANGL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:BOYS TOWN NATIONAL RESEARCH HOSPITAL AUDIOLOGY DEPARTME
Mailing Address - Street 2:555 NORTH 30TH STREET
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131
Mailing Address - Country:US
Mailing Address - Phone:402-498-6536
Mailing Address - Fax:402-452-5015
Practice Address - Street 1:BOYS TOWN NATIONAL RESEARCH HOSPITAL AUDIOLOGY DEPARTME
Practice Address - Street 2:555 NORTH 30TH STREET
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131
Practice Address - Country:US
Practice Address - Phone:402-498-6536
Practice Address - Fax:402-452-5015
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE900801237700000X
NE143237700000X
NE317231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1457458556Medicaid