Healthcare Provider Details

I. General information

NPI: 1003173451
Provider Name (Legal Business Name): MARIA SUZANNE KRUSEMARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MOULTON AND PARSONS DR
SAINT JAMES MN
56081-5550
US

IV. Provider business mailing address

1225 200TH ST
TRIMONT MN
56176-1230
US

V. Phone/Fax

Practice location:
  • Phone: 413-786-8000
  • Fax:
Mailing address:
  • Phone: 928-308-7671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number076314
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8079
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: