MEDICARE: CORTNEY SUE KRUGMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	7101007620	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7101007620	OTHER	MI	STATE OF MICHIGAN SLP LICENSE

General Provider Information

NPI Number	:	1528864253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORTNEY SUE KRUGMAN

Provider Business Mailing Address
First Line	:	202 W SHIAWASSEE AVE STE 114
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-2093
Country	:	US
Telephone Number	:	616-710-2817
Fax Number	:

Provider Business Practice Location Address
First Line	:	3110 LEDGESTONE PL NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-7067
Country	:	US
Telephone Number	:	616-710-2817
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2025
Last Update Date	:	04/07/2025

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Directions to “ CORTNEY SUE KRUGMAN ” Practice Location

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