Provider Demographics
NPI:1427495886
Name:KURJAN, RANDY M (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:RANDY
Middle Name:M
Last Name:KURJAN
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 1:8 FERNWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-1811
Mailing Address - Country:US
Mailing Address - Phone:301-908-0567
Mailing Address - Fax:
Practice Address - Street 1:8 FERNWOOD TRL
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-1811
Practice Address - Country:US
Practice Address - Phone:301-908-0567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5252235Z00000X
MD02539235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist