Provider Demographics
NPI:1528864253
Name:KRUGMAN, CORTNEY SUE
Entity type:Individual
Prefix:
First Name:CORTNEY
Middle Name:SUE
Last Name:KRUGMAN
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 1:202 W SHIAWASSEE AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2093
Mailing Address - Country:US
Mailing Address - Phone:616-710-2817
Mailing Address - Fax:
Practice Address - Street 1:3110 LEDGESTONE PL NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7067
Practice Address - Country:US
Practice Address - Phone:616-710-2817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101007620235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7101007620OtherSTATE OF MICHIGAN SLP LICENSE