Provider Demographics
NPI:1699475269
Name:BANGERT, KATHERINE JOANN (PHD, CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:JOANN
Last Name:BANGERT
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
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Other - First Name:
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Mailing Address - Street 1:10300 CITY WALK DR UNIT 432E
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-6953
Mailing Address - Country:US
Mailing Address - Phone:715-425-4154
Mailing Address - Fax:
Practice Address - Street 1:410 S 3RD ST
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-5010
Practice Address - Country:US
Practice Address - Phone:715-425-4154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6165154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist