Provider Demographics
NPI:1336698745
Name:MUVCESKI, KRISTINA (SLPA, ITDS, CD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:MUVCESKI
Suffix:
Gender:F
Credentials:SLPA, ITDS, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 CUADRO PL
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4908
Mailing Address - Country:US
Mailing Address - Phone:386-344-2911
Mailing Address - Fax:
Practice Address - Street 1:112 CUADRO PL
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4908
Practice Address - Country:US
Practice Address - Phone:386-344-2911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI28642355S0801X
374J00000X
FL252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty