Margaret Elizabeth Dvergsten-Kitzrow, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

9629 Issued in MN

Practice address

6542 Kingfisher LN
Eden Prairie, MN 55346-1830

Phone

(712) 291-6721

NPI assigned

Aug 16, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1471305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471305600000",
    "number": "1043765316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6542 KINGFISHER LN",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553461830",
            "telephone_number": "712-291-6721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6542 KINGFISHER LN",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553461830",
            "telephone_number": "712-291-6721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DVERGSTEN-KITZROW",
        "first_name": "MARGARET",
        "middle_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-16",
        "last_updated": "2016-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "9629",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "SP24499",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IA",
            "license": "002172",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Edan Oak LLC (Edan Oak assisted living)

• Speech-Language Pathologist in Eden Prairie, MN
• Providers in Eden Prairie, MN by specialty
• Speech-Language Pathologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.