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General NPI Number Information
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NPI Number | 1629686985
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Entity Type | Individual
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Provider Name | LYDIA R KRUSE MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 07/22/2020
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 2320 CONCORD RD STE A
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City | LAFAYETTE
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State | IN
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Zip | 47909-2710
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Country | US
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Telephone | 765-477-7436
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Fax | 765-477-1245
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Provider Business Mailing Address
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Address Line | PO BOX 781076
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City | DETROIT
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State | MI
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Zip | 48278-1076
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Country | US
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Telephone | 317-528-4800
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Fax | 317-865-1479
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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 | 22005444A
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License Number State | IN
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