Provider Demographics
NPI:1548478340
Name:KRUESSEL, LORAINE ELIZABETH (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:LORAINE
Middle Name:ELIZABETH
Last Name:KRUESSEL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 QUAIL HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4649
Mailing Address - Country:US
Mailing Address - Phone:614-736-6820
Mailing Address - Fax:
Practice Address - Street 1:4353 TULLER RD
Practice Address - Street 2:SUITE D
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-5071
Practice Address - Country:US
Practice Address - Phone:614-764-7900
Practice Address - Fax:614-764-0715
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8790235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist