Healthcare Provider Details

I. General information

NPI: 1588971758
Provider Name (Legal Business Name): ALLISON T KRUTUL PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 CURTIS RD PSYCHOLOGY
CHAMPAIGN IL
61822-9678
US

IV. Provider business mailing address

PO BOX 6002
URBANA IL
61803-6002
US

V. Phone/Fax

Practice location:
  • Phone: 217-365-6206
  • Fax: 217-326-4003
Mailing address:
  • Phone: 217-326-8630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: