Provider Demographics
NPI:1902351505
Name:BERGELEEN, LAURA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BERGELEEN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23416 370TH AVE
Mailing Address - Street 2:
Mailing Address - City:WESSINGTON SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57382
Mailing Address - Country:US
Mailing Address - Phone:605-680-4610
Mailing Address - Fax:
Practice Address - Street 1:612 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:PLATTE
Practice Address - State:SD
Practice Address - Zip Code:57369-2117
Practice Address - Country:US
Practice Address - Phone:605-337-2636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD266-SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist