Provider Demographics
NPI:1073232922
Name:MESSER-KRUSE, CONNOR (CF-SLP)
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:
Last Name:MESSER-KRUSE
Suffix:
Gender:M
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 WYNDHURST RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-1421
Mailing Address - Country:US
Mailing Address - Phone:419-787-7476
Mailing Address - Fax:
Practice Address - Street 1:1609 N SUMMIT ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-1806
Practice Address - Country:US
Practice Address - Phone:419-671-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.20222126-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist