Healthcare Provider Details

I. General information

NPI: 1104432004
Provider Name (Legal Business Name): HANNAH N KRUEGER PSY. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 EAST CHEVY CHASE DRIVE SUITE #204
GLENDALE CA
91206-4139
US

IV. Provider business mailing address

P.O. BOX 251377
GLENDALE CA
91225-1377
US

V. Phone/Fax

Practice location:
  • Phone: 818-230-7292
  • Fax: 818-660-2694
Mailing address:
  • Phone: 818-230-7292
  • Fax: 818-660-2694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY32038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: