Provider Demographics
NPI:1659418150
Name:KREKOW, CHRISTINE MARY DAENZER (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MARY DAENZER
Last Name:KREKOW
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6625 DEVONSHIRE AVE
Mailing Address - Street 2:APT.2E
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2511
Mailing Address - Country:US
Mailing Address - Phone:314-941-6819
Mailing Address - Fax:
Practice Address - Street 1:6625 DEVONSHIRE AVE
Practice Address - Street 2:APT.2E
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2511
Practice Address - Country:US
Practice Address - Phone:314-941-6819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2005021701235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist