Provider Demographics
NPI:1548637424
Name:ACKERMAN, KRISTEN RAE (MA, CF-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:RAE
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:RAE
Other - Last Name:SCUDIERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2606
Mailing Address - Country:US
Mailing Address - Phone:614-980-3904
Mailing Address - Fax:
Practice Address - Street 1:9200 US HIGHWAY 42 S
Practice Address - Street 2:
Practice Address - City:PLAIN CITY
Practice Address - State:OH
Practice Address - Zip Code:43064-9238
Practice Address - Country:US
Practice Address - Phone:614-980-3904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.2016061-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist