Provider Demographics
NPI:1124594031
Name:KUECKER, KARRRIE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KARRRIE
Middle Name:
Last Name:KUECKER
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 1:15801 S 48TH ST APT 1132
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0844
Mailing Address - Country:US
Mailing Address - Phone:734-344-1284
Mailing Address - Fax:
Practice Address - Street 1:15810 S 42ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-7409
Practice Address - Country:US
Practice Address - Phone:480-759-0358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP10549235Z00000X
LA7519235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist