Provider Demographics
NPI:1871626432
Name:KRUPIT, ELISABETH (MS SLP)
Entity type:Individual
Prefix:MS
First Name:ELISABETH
Middle Name:
Last Name:KRUPIT
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 ATLANTA HWY STE 701
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-1255
Mailing Address - Country:US
Mailing Address - Phone:678-644-0819
Mailing Address - Fax:678-658-9094
Practice Address - Street 1:2450 ATLANTA HWY STE 1001
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-1252
Practice Address - Country:US
Practice Address - Phone:678-644-0819
Practice Address - Fax:678-658-9094
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006494235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA880952263CMedicaid
GASLP006494OtherSTATE LICENSE NO