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General NPI Number Information
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NPI Number | 1003173451
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Entity Type | Individual
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Provider Name | MARIA SUZANNE KRUSEMARK
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Gender | Female
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Dates
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Enumeration Date | 04/23/2012
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 1101 MOULTON AND PARSONS DR
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City | SAINT JAMES
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State | MN
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Zip | 56081-5550
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Country | US
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Telephone | 413-786-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 1225 200TH ST
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City | TRIMONT
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State | MN
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Zip | 56176-1230
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Country | US
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Telephone | 928-308-7671
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 076314
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 8079
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License Number State | MA
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