Provider Demographics
NPI:1821367442
Name:AGARD, SUSAN KUENSLI (MS)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KUENSLI
Last Name:AGARD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1373 SERVAIS ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-3135
Mailing Address - Country:US
Mailing Address - Phone:920-819-6052
Mailing Address - Fax:
Practice Address - Street 1:1373 SERVAIS ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-3135
Practice Address - Country:US
Practice Address - Phone:920-819-6052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI01076978OtherASHA