Healthcare Provider Details

I. General information

NPI: 1699412668
Provider Name (Legal Business Name): LAYNEE R KUDRNA M.S. CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 1ST ST E
DICKINSON ND
58601-5211
US

IV. Provider business mailing address

140 1ST ST E
DICKINSON ND
58601-5211
US

V. Phone/Fax

Practice location:
  • Phone: 701-300-0019
  • Fax: 701-483-0060
Mailing address:
  • Phone: 701-300-0019
  • Fax: 701-483-0060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2076
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: