Provider Demographics
NPI:1912023540
Name:RANGITSCH, SUSAN MICHAL (EDD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MICHAL
Last Name:RANGITSCH
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7235 OLD GRANT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808
Mailing Address - Country:US
Mailing Address - Phone:406-251-6698
Mailing Address - Fax:406-251-6698
Practice Address - Street 1:7235 OLD GRANT CREEK RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-9038
Practice Address - Country:US
Practice Address - Phone:406-251-6698
Practice Address - Fax:406-251-6698
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT58101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional