Provider Demographics
NPI:1538697487
Name:KRUMENACKER, SUZANNE (AUD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:KRUMENACKER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 BOUDINOT CT
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-6224
Mailing Address - Country:US
Mailing Address - Phone:858-829-4812
Mailing Address - Fax:
Practice Address - Street 1:16486 BERNARDO CENTER DR STE 338
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2530
Practice Address - Country:US
Practice Address - Phone:858-829-4812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU17132355A2700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology AssistantGroup - Single Specialty