Provider Demographics
NPI:1225696099
Name:TROESCHER, KIRSTEN HOLMBERG (MS, SLP)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:HOLMBERG
Last Name:TROESCHER
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:EILEEN
Other - Last Name:HOLMBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, SLP
Mailing Address - Street 1:4526 MACKINAC ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-8778
Mailing Address - Country:US
Mailing Address - Phone:727-239-1370
Mailing Address - Fax:
Practice Address - Street 1:6245 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6006
Practice Address - Country:US
Practice Address - Phone:727-376-1111
Practice Address - Fax:727-376-1113
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ9044235Z00000X
NC14396235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC14396OtherNC BOARD OF SPEECH LANGUAGE PATHOLOGY & AUDIOLOGY
FLSZ9044OtherST OF FL DEPT OF HEALTH BD OF SPEECH PATHOLOGY
FLSA17907OtherST OF FL DEPT OF HEALTH BD OF SPEECH PATHOLOGY