Provider Demographics
NPI:1689775165
Name:DELEEUW, CHRISTINA LEE-KRIZ (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:LEE-KRIZ
Last Name:DELEEUW
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:KRIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:741 PARK BROOK RD
Mailing Address - Street 2:
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040-7039
Mailing Address - Country:US
Mailing Address - Phone:763-712-9490
Mailing Address - Fax:
Practice Address - Street 1:300 COON RAPIDS BLVD NW
Practice Address - Street 2:SUITE #200
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5643
Practice Address - Country:US
Practice Address - Phone:763-767-0854
Practice Address - Fax:763-862-6533
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7751235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP45789OtherHEALTH PARTNERS
MN213G3KROtherBLUE CROSS BLUE SHIELD
MN246533Medicare ID - Type UnspecifiedHEALTH DIMENSIONS REHAB