Provider Demographics
NPI:1710072970
Name:KRUZA, CAROLYN MARIE (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:MARIE
Last Name:KRUZA
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:MARIE
Other - Last Name:REUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC/SLP
Mailing Address - Street 1:4754 SENSENY RD
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22611-3334
Mailing Address - Country:US
Mailing Address - Phone:540-955-2224
Mailing Address - Fax:
Practice Address - Street 1:1840 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2808
Practice Address - Country:US
Practice Address - Phone:540-536-1126
Practice Address - Fax:540-536-5139
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002446235Z00000X
WVSLP-0435235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01065664OtherASHA CERTIFICATION
VA2202002446OtherVA SLP LICENSE
WV0154326000Medicaid
WVSLP-0435OtherWV SLP LICENSE