Provider Demographics
NPI:1891521464
Name:KRDZIC, AMINA
Entity type:Individual
Prefix:
First Name:AMINA
Middle Name:
Last Name:KRDZIC
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 1:822 MIDDLEBORO DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-3212
Mailing Address - Country:US
Mailing Address - Phone:314-546-0715
Mailing Address - Fax:
Practice Address - Street 1:401 CORPORATE PARK DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-4201
Practice Address - Country:US
Practice Address - Phone:314-725-7447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024036624235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist