Provider Demographics
NPI:1811293889
Name:TRUDEL, KIERAN M
Entity type:Individual
Prefix:
First Name:KIERAN
Middle Name:M
Last Name:TRUDEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41689 ENTERPRISE CIR N
Mailing Address - Street 2:SUITE 118
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5630
Mailing Address - Country:US
Mailing Address - Phone:951-541-0615
Mailing Address - Fax:951-332-9498
Practice Address - Street 1:41689 ENTERPRISE CIR N
Practice Address - Street 2:SUITE 118
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5630
Practice Address - Country:US
Practice Address - Phone:951-541-0615
Practice Address - Fax:951-332-9498
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6175235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist