MEDICARE: MRS. KIMBERLY A KRUTHAUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1629373576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY A KRUTHAUP

Provider Business Mailing Address
First Line	:	7111 CROFT FARM DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-5741
Country	:	US
Telephone Number	:	513-254-3243
Fax Number	:

Provider Business Practice Location Address
First Line	:	7111 CROFT FARM DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-5741
Country	:	US
Telephone Number	:	513-254-3243
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2011
Last Update Date	:	02/10/2014

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