Provider Demographics
NPI:1952728859
Name:FUSCO, KRISTEN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:FUSCO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:MCCLELLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:141 PURITAN DR
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-6731
Mailing Address - Country:US
Mailing Address - Phone:914-713-8536
Mailing Address - Fax:
Practice Address - Street 1:141 PURITAN DR
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-6731
Practice Address - Country:US
Practice Address - Phone:914-713-8536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013467-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist