Provider Demographics
NPI:1033298096
Name:KREUTZ, KARA LESE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:LESE
Last Name:KREUTZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2968 STATE HIGHWAY 49 STE D
Mailing Address - Street 2:
Mailing Address - City:COOL
Mailing Address - State:CA
Mailing Address - Zip Code:95614-9478
Mailing Address - Country:US
Mailing Address - Phone:530-887-9598
Mailing Address - Fax:530-887-9512
Practice Address - Street 1:2968 STATE HIGHWAY 49 STE D
Practice Address - Street 2:
Practice Address - City:COOL
Practice Address - State:CA
Practice Address - Zip Code:95614-9478
Practice Address - Country:US
Practice Address - Phone:530-887-9598
Practice Address - Fax:530-887-9512
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13073235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist