Healthcare Provider Details

I. General information

NPI: 1801950381
Provider Name (Legal Business Name): BERNARD L. KRUSE ED.S., NCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32919 W CENTER ST
WITTMANN AZ
85361-9433
US

IV. Provider business mailing address

32919 W CENTER ST
WITTMANN AZ
85361-9433
US

V. Phone/Fax

Practice location:
  • Phone: 623-388-2321
  • Fax: 623-388-2915
Mailing address:
  • Phone: 623-388-2321
  • Fax: 623-388-2915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: