Provider Demographics
NPI:1356159248
Name:KLOUSNER, MARTHA KAI (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:KAI
Last Name:KLOUSNER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 BARTLETT ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7000
Mailing Address - Country:US
Mailing Address - Phone:907-226-5655
Mailing Address - Fax:907-235-0869
Practice Address - Street 1:4300 BARTLETT ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7000
Practice Address - Country:US
Practice Address - Phone:907-226-5655
Practice Address - Fax:907-235-0869
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK213310235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist