Provider Demographics
NPI:1811382195
Name:HURLEY VANGERUD, HEATHER MARLENE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MARLENE
Last Name:HURLEY VANGERUD
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 1:1772 STEIGER LAKE LN
Mailing Address - Street 2:PO BOX 34
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-7723
Mailing Address - Country:US
Mailing Address - Phone:952-443-9888
Mailing Address - Fax:
Practice Address - Street 1:1772 STEIGER LAKE LN
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:MN
Practice Address - Zip Code:55386-7723
Practice Address - Country:US
Practice Address - Phone:952-443-9888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5514235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN169036OtherUCARE
MN4600402OtherMEDICA
MN001442700Medicaid
MN1311578OtherCIGNA
MN5658810228803OtherPREFERRED ONE
MN76842OtherHEALTHPARTNERS
MN017J6KIOtherBCBS