Provider Demographics
NPI:1871012377
Name:KRUEDEWAGEN, CHLOE (SLP)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:
Last Name:KRUEDEWAGEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14300 HAMILTON POOL RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-7703
Mailing Address - Country:US
Mailing Address - Phone:512-533-7973
Mailing Address - Fax:
Practice Address - Street 1:14300 HAMILTON POOL RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-7703
Practice Address - Country:US
Practice Address - Phone:512-533-7973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111323235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111323OtherSLP LICENSE