Provider Demographics
NPI:1437202454
Name:SORG-HACKLER, CHERI LEIGH (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHERI
Middle Name:LEIGH
Last Name:SORG-HACKLER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 SANDERS AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6207
Mailing Address - Country:US
Mailing Address - Phone:406-582-7819
Mailing Address - Fax:
Practice Address - Street 1:720 STONERIDGE DR
Practice Address - Street 2:UNIT 2
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7032
Practice Address - Country:US
Practice Address - Phone:406-556-9853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1079235Z00000X
FLSA 5031235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist