Provider Demographics
NPI:1265704282
Name:CRUZ, KRISTEN MICHELLE (SLPA)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:MICHELLE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:MICHELLE
Other - Last Name:KALDAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLPA
Mailing Address - Street 1:5901 SW 74TH ST
Mailing Address - Street 2:SUITE 411
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5165
Mailing Address - Country:US
Mailing Address - Phone:305-740-9688
Mailing Address - Fax:
Practice Address - Street 1:5901 SW 74TH ST
Practice Address - Street 2:SUITE 411
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5165
Practice Address - Country:US
Practice Address - Phone:305-740-9688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI 19032355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant