| Doctor Name: | MRS. KELLEY SUZANNE BUMGARDANER |
| NPI Number: | 1720154248 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, CCC-SLP |
| License Number: | MO01965 |
| Business Practice Address: | 801 Brim St Desloge, MO - 636013441 |
| Business Phone Number: | 5734310223 |
| Business Fax Number: | 5734310251 |
| Mailing Address: | Po Box 625, 203 Kingsbury Blvd. FREDERICKTOWN |
| State: | MO |
| Postal Code: | 636450625 |
| Phone Number: | 5737837043 |
| Fax Number: | 5734310251 |
| NPI Enumeration Date: | 11/27/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | MO01965 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |