Provider Demographics
NPI:1003173451
Name:KRUSEMARK, MARIA SUZANNE
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:SUZANNE
Last Name:KRUSEMARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 200TH ST
Mailing Address - Street 2:
Mailing Address - City:TRIMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56176-1230
Mailing Address - Country:US
Mailing Address - Phone:928-308-7671
Mailing Address - Fax:
Practice Address - Street 1:1101 MOULTON AND PARSONS DR
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MN
Practice Address - Zip Code:56081-5550
Practice Address - Country:US
Practice Address - Phone:413-786-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA076314235Z00000X
MA8079235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist