Provider Demographics
NPI:1366750994
Name:VEGSUND, SUSAN KAY
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:VEGSUND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 SYLVAN AVE # 150
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-2083
Mailing Address - Country:US
Mailing Address - Phone:214-743-6159
Mailing Address - Fax:
Practice Address - Street 1:1881 SYLVAN AVE STE 150
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2083
Practice Address - Country:US
Practice Address - Phone:214-743-6159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6120235Z00000X
TX109423235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist