Provider Demographics
NPI:1609198464
Name:KUZEMKA, DAVID WILLIAM (SLP)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WILLIAM
Last Name:KUZEMKA
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:MARIONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65705-9340
Mailing Address - Country:US
Mailing Address - Phone:417-258-2573
Mailing Address - Fax:
Practice Address - Street 1:205 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MARIONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65705-9340
Practice Address - Country:US
Practice Address - Phone:417-258-2573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112642235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist