Provider Demographics
NPI:1295121093
Name:BANGERT, SUSAN GAIL (MA CCC/SP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:GAIL
Last Name:BANGERT
Suffix:
Gender:F
Credentials:MA CCC/SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W KENNEDY ST
Mailing Address - Street 2:
Mailing Address - City:ALGONA
Mailing Address - State:IA
Mailing Address - Zip Code:50511-3126
Mailing Address - Country:US
Mailing Address - Phone:515-295-9505
Mailing Address - Fax:
Practice Address - Street 1:108 W KENNEDY ST
Practice Address - Street 2:
Practice Address - City:ALGONA
Practice Address - State:IA
Practice Address - Zip Code:50511-3126
Practice Address - Country:US
Practice Address - Phone:515-295-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0649235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist