Healthcare Provider Details

I. General information

NPI: 1558308189
Provider Name (Legal Business Name): LONA KUSER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 W CALL ST
STARKE FL
32091-3115
US

IV. Provider business mailing address

2162 NE 154TH ST
STARKE FL
32091-6418
US

V. Phone/Fax

Practice location:
  • Phone: 904-964-4464
  • Fax:
Mailing address:
  • Phone: 904-964-4464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA3045
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: