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General NPI Number Information
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NPI Number | 1750403101
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Entity Type | Individual
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Provider Name | SUSAN MARIE PANGER LMFT LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/05/2007
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Last Update Date | 09/14/2010
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Provider Practice Location Address
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Address Line | 811 60TH ST 2E
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City | KENOSHA
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State | WI
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Zip | 53140-4074
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Country | US
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Telephone | 262-652-9599
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Fax | 262-652-0009
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Provider Business Mailing Address
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Address Line | PO BOX 96
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City | KENOSHA
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State | WI
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Zip | 53141-0096
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Country | US
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Telephone | 262-652-9599
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Fax | 262-652-0009
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2606-123
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 558-124
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License Number State | WI
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