Doctor Name: | MARIA S. KRUSEMARK |
NPI Number: | 1003173451 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 4435 |
Business Practice Address: | 55 Cooper St Agawam, MA - 010012149 |
Business Phone Number: | 4137868000 |
Business Fax Number: | |
Mailing Address: | 66 Milo Peck Ln, WINDSOR |
State: | CT |
Postal Code: | 060951807 |
Phone Number: | 9283087671 |
Fax Number: | |
NPI Enumeration Date: | 04/23/2012 |
NPI Last Update Date: | 04/23/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 4435 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CT |
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 |