Provider Demographics
NPI:1699988592
Name:ZURBUCH, KRISTEN JOY (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:JOY
Last Name:ZURBUCH
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 1:3117 PAWNEE CT
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:IN
Mailing Address - Zip Code:46774-2930
Mailing Address - Country:US
Mailing Address - Phone:260-414-5314
Mailing Address - Fax:260-493-9785
Practice Address - Street 1:3117 PAWNEE CT
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774-2930
Practice Address - Country:US
Practice Address - Phone:260-414-5314
Practice Address - Fax:260-493-9785
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003134A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200650910Medicaid