Provider Demographics
NPI:1124229570
Name:KRUSE, SUZANNE L
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:L
Last Name:KRUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 PIRATE LN
Mailing Address - Street 2:P. O. BOX 192
Mailing Address - City:NORBORNE
Mailing Address - State:MO
Mailing Address - Zip Code:64668-1382
Mailing Address - Country:US
Mailing Address - Phone:660-593-3319
Mailing Address - Fax:660-593-3657
Practice Address - Street 1:405 PIRATE LN
Practice Address - Street 2:
Practice Address - City:NORBORNE
Practice Address - State:MO
Practice Address - Zip Code:64668-1382
Practice Address - Country:US
Practice Address - Phone:660-593-3319
Practice Address - Fax:660-593-3657
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist