Healthcare Provider Details

I. General information

NPI: 1700907201
Provider Name (Legal Business Name): DONNA KRENZ DT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 ADAMS ST
OTTAWA IL
61350-4304
US

IV. Provider business mailing address

1013 ADAMS ST
OTTAWA IL
61350-4304
US

V. Phone/Fax

Practice location:
  • Phone: 815-434-0857
  • Fax: 815-434-2260
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberDK34890806P
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: