Provider Demographics
NPI:1760444970
Name:BUGENHAGEN, CROSBY (MS, ATC, LAT)
Entity Type:Individual
Prefix:MISS
First Name:CROSBY
Middle Name:
Last Name:BUGENHAGEN
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8020 S HOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-2930
Mailing Address - Country:US
Mailing Address - Phone:414-647-3920
Mailing Address - Fax:414-465-4730
Practice Address - Street 1:8020 S HOWELL AVE
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-2930
Practice Address - Country:US
Practice Address - Phone:414-647-3920
Practice Address - Fax:414-465-4730
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer