| Doctor Name: | KELLY MARIE KRUCKEBERG |
| NPI Number: | 1952478588 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S., CCC-SLP |
| License Number: | 7955 |
| Business Practice Address: | 3800 Park Nicollet Blvd St Louis Park, MN - 554162527 |
| Business Phone Number: | 9529931029 |
| Business Fax Number: | |
| Mailing Address: | 3800 Park Nicollet Blvd, ST LOUIS PARK |
| State: | MN |
| Postal Code: | 554162527 |
| Phone Number: | 9529931029 |
| Fax Number: | |
| NPI Enumeration Date: | 11/29/2006 |
| NPI Last Update Date: | 04/07/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 7955 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| 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 |