Provider Demographics
NPI:1588864391
Name:KRUSEMARK, CAROL KATHERINE (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:KATHERINE
Last Name:KRUSEMARK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 EARL RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1353
Mailing Address - Country:US
Mailing Address - Phone:617-726-0220
Mailing Address - Fax:617-643-2229
Practice Address - Street 1:1 BOWDOIN SQ FL 11
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2919
Practice Address - Country:US
Practice Address - Phone:617-726-0220
Practice Address - Fax:617-643-2229
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA11989235Z00000X
MA7801235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist