Provider Demographics
NPI:1366978223
Name:KRUEGER, SUSAN E (MS, SLP-CCC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 DRIFTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-9517
Mailing Address - Country:US
Mailing Address - Phone:406-209-5787
Mailing Address - Fax:
Practice Address - Street 1:720 STONERIDGE DR
Practice Address - Street 2:SUITE #1
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7032
Practice Address - Country:US
Practice Address - Phone:406-556-9853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSLP-SP-TMP-6292235Z00000X
MTSLP-SP-LIC-8765235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist