Provider Demographics
NPI:1255754560
Name:KROOVAND, JUDITH (MASTERS IN SPEECH/LA)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:KROOVAND
Suffix:
Gender:F
Credentials:MASTERS IN SPEECH/LA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CHIPPEWAY CT
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8934
Mailing Address - Country:US
Mailing Address - Phone:386-445-1150
Mailing Address - Fax:
Practice Address - Street 1:4875 PALM COAST PKWY NW
Practice Address - Street 2:SUITE 2
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3670
Practice Address - Country:US
Practice Address - Phone:386-446-9935
Practice Address - Fax:386-446-7777
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI27262355S0801X
FLSZ 6536235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSI2726OtherFLORIDA DEPARTMENT OF HEALTH