Healthcare Provider Details

I. General information

NPI: 1932495660
Provider Name (Legal Business Name): KRISTEN CUFFARI SL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23825 COMMERCE PARK SUITE B
BEACHWOOD OH
44122-5837
US

IV. Provider business mailing address

23825 COMMERCE PARK SUITE B
BEACHWOOD OH
44122-5837
US

V. Phone/Fax

Practice location:
  • Phone: 216-292-7370
  • Fax: 216-292-7042
Mailing address:
  • Phone: 216-292-7370
  • Fax: 216-292-7042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP8967
License Number StateOH

VIII. Authorized Official

Name: NANCY THEOFRASTOUS I
Title or Position: CO-OWNER
Credential: SLP
Phone: 216-292-7370