Provider Demographics
NPI:1043765316
Name:DVERGSTEN-KITZROW, MARGARET ELIZABETH (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:ELIZABETH
Last Name:DVERGSTEN-KITZROW
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6542 KINGFISHER LN
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55346-1830
Mailing Address - Country:US
Mailing Address - Phone:712-291-6721
Mailing Address - Fax:
Practice Address - Street 1:6542 KINGFISHER LN
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55346-1830
Practice Address - Country:US
Practice Address - Phone:712-291-6721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9629235Z00000X
CASP24499235Z00000X
IA002172235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist