Provider Demographics
NPI:1053445718
Name:KUDARAUSKAS, KRISTIN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:
Last Name:KUDARAUSKAS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8723 LAROQUE RUN DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-1991
Mailing Address - Country:US
Mailing Address - Phone:540-693-0322
Mailing Address - Fax:
Practice Address - Street 1:8723 LAROQUE RUN DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-1991
Practice Address - Country:US
Practice Address - Phone:540-693-0322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05696235Z00000X
VA2202005451235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist