Provider Demographics
NPI:1891119673
Name:DODUS, KRISTINA (MA CCC/SLP)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:DODUS
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20025 LUNN RD
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44149-4925
Mailing Address - Country:US
Mailing Address - Phone:440-268-5911
Mailing Address - Fax:
Practice Address - Street 1:20025 LUNN RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44149-4925
Practice Address - Country:US
Practice Address - Phone:440-268-5911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-4651235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist