Provider Demographics
NPI:1447054176
Name:BRUNGARDT, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BRUNGARDT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:CZARNICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1301 E GROVE AVE UNIT B6
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-6129
Mailing Address - Country:US
Mailing Address - Phone:402-270-6465
Mailing Address - Fax:
Practice Address - Street 1:401 ADAM ST
Practice Address - Street 2:
Practice Address - City:SCHUYLER
Practice Address - State:NE
Practice Address - Zip Code:68661-2468
Practice Address - Country:US
Practice Address - Phone:402-352-9940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE0872355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant