Provider Demographics
NPI:1306455175
Name:CRUZ, ADRIENNE CELINE SAN DIEGO (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ADRIENNE CELINE
Middle Name:SAN DIEGO
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MRS
Other - First Name:ADRIENNE CELINE
Other - Middle Name:CRUZ
Other - Last Name:PASMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:4071 POND RUN CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2179
Mailing Address - Country:US
Mailing Address - Phone:734-968-7157
Mailing Address - Fax:
Practice Address - Street 1:161 S WAKEA AVE
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1343
Practice Address - Country:US
Practice Address - Phone:808-244-7467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1869235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist