Provider Demographics
NPI:1659936383
Name:SORG, DANA (SLP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:SORG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 TRADE WIND LN APT 23
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-4633
Mailing Address - Country:US
Mailing Address - Phone:406-579-6632
Mailing Address - Fax:
Practice Address - Street 1:1122 E MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3888
Practice Address - Country:US
Practice Address - Phone:406-570-9465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist