Kyrstina Hudson Mariouw, PH.D

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

6301018301 Issued in MI

Practice address

3290 W Big Beaver Rd Ste 150
Troy, MI 48084-2931

Phone

(248) 792-6527

Fax

(248) 792-9106

NPI assigned

Aug 27, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kyrstina Hudson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1409097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607385600000",
    "number": "1487054441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1335 SHEEHAN AVE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481043837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3290 W BIG BEAVER RD STE 150",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480842931",
            "telephone_number": "248-792-6527",
            "fax_number": "248-792-9106"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1375 55th St",
            "address_purpose": "LOCATION",
            "city": "Emeryville",
            "state": "CA",
            "postal_code": "946082609",
            "country_code": "US",
            "telephone_number": "510-655-7880",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARIOUW",
        "first_name": "KYRSTINA",
        "middle_name": "HUDSON",
        "credential": "PH.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-27",
        "last_updated": "2020-12-08",
        "certification_date": "2020-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MI",
            "license": "6301018301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KYRSTINA",
            "last_name": "HUDSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Monica S Marciniak, M.A., CCC-SLP
• Gabriela Rodriguez Marcozzi, MA, SCL, LLC
• Alex James Marcum
• Peter Mardo
• Jodi Marini, RN
• Mark J. Scapini, M.D., P.L.L.C.
• Mark P Koniuch MD PC
• Mark S Friedland MD PC
• Mark Schare PC
• Mark Zohoury

• Clinical Neuropsychologist in Troy, MI
• Providers in Troy, MI by specialty
• Clinical Neuropsychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.