Provider Demographics
NPI:1790238228
Name:DUSELLIER, KRYSTIN L (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTIN
Middle Name:L
Last Name:DUSELLIER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:KRYSTIN
Other - Middle Name:L
Other - Last Name:ANGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:44738 MORLEY DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-1357
Mailing Address - Country:US
Mailing Address - Phone:586-421-4062
Mailing Address - Fax:
Practice Address - Street 1:44738 MORLEY DR
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-1357
Practice Address - Country:US
Practice Address - Phone:586-421-4062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101005138235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist