MEDICARE: MRS. BRENDA ANN KRUL M.S.S.A., L.I.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	I-0009761	OH

General Provider Information

NPI Number	:	1255462388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRENDA ANN KRUL M.S.S.A., L.I.S.W.

Provider Business Mailing Address
First Line	:	12104 WILLARD AVE
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-3618
Country	:	US
Telephone Number	:	216-663-2024
Fax Number	:

Provider Business Practice Location Address
First Line	:	5706 TURNEY RD
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-3971
Country	:	US
Telephone Number	:	216-518-9271
Fax Number	:	216-518-9298

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/08/2007

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