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NPI Code Detail

MEDICARE: VICTORIA ANNE HENSLEY PRZULJ SSP, NCSP

MEDICARE: VICTORIA ANNE HENSLEY PRZULJ SSP, NCSP
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
1103TS0200XSchool Psychologist2350667IL

General Provider Information

NPI Number : 1821767815
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICTORIA ANNE HENSLEY PRZULJ SSP, NCSP
Provider Business Mailing Address
First Line : 105 W A ST
Second Line :
City : BELLEVILLE
State : IL
Zip : 62220-1326
Country : US
Telephone Number : 618-233-2830
Fax Number :
Provider Business Practice Location Address
First Line : 105 W A ST
Second Line :
City : BELLEVILLE
State : IL
Zip : 62220-1326
Country : US
Telephone Number : 618-233-2830
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2021
Last Update Date : 09/13/2021

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