Individual provider Active NPI

Kristin Kudarauskas, M.S., CCC-SLP

  • Speech-Language Pathologist
  • Fredericksburg, VA
National Provider Identifier
1053445718
Registry record updated Sep 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
2202005451 Issued in VA
Practice address
8723 Laroque Run Dr
Fredericksburg, VA 22407-1991
Phone
(540) 693-0322
NPI assigned
Mar 15, 2007
Last updated
Sep 21, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 05696 MD
Speech-Language Pathologist 235Z00000X 2202005451 VA Primary

Addresses

Primary practice location

8723 Laroque Run Dr
Fredericksburg, VA 22407-1991

Mailing address

8723 Laroque Run Dr
Fredericksburg, VA 22407-1991
Phone (540) 693-0322

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
05696MDMDSpeech-Language Pathologist
2202005451VAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Chancellor Therapy Solutions Speech-Language Pathologist CurrentSince Jul 27, 2020 Accepting new patients
Bayada Home Health Care, Inc. Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600646400000",
    "number": "1053445718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8723 LAROQUE RUN DR",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224071991",
            "telephone_number": "540-693-0322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8723 LAROQUE RUN DR",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224071991",
            "telephone_number": "540-693-0322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUDARAUSKAS",
        "first_name": "KRISTIN",
        "name_prefix": "Ms.",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-15",
        "last_updated": "2020-09-21",
        "certification_date": "2020-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MD",
            "license": "05696",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2202005451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fredericksburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2020; 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.