Provider Demographics
NPI:1083819783
Name:STURWOLD, KRISTINA RENE (MA, CCC, SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:RENE
Last Name:STURWOLD
Suffix:
Gender:F
Credentials:MA, CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9714 FORTUNE DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9047
Mailing Address - Country:US
Mailing Address - Phone:317-849-1409
Mailing Address - Fax:317-576-8084
Practice Address - Street 1:9714 FORTUNE DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9047
Practice Address - Country:US
Practice Address - Phone:317-849-1409
Practice Address - Fax:317-576-8084
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002889A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist