Provider Demographics
NPI:1134346703
Name:DUDA, KRISTIN JANA (MS, SLP-CCC)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:JANA
Last Name:DUDA
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4930 CLEARWATER DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6682
Mailing Address - Country:US
Mailing Address - Phone:410-461-5045
Mailing Address - Fax:
Practice Address - Street 1:7300 GOLDEN FERN CT
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-5946
Practice Address - Country:US
Practice Address - Phone:410-796-8499
Practice Address - Fax:443-270-8260
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04126235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist