Healthcare Provider Details

I. General information

NPI: 1710203476
Provider Name (Legal Business Name): LINDA S KRANITZ PHD, HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 04/02/2025
Certification Date: 03/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

482 S LANDMARK AVE
BLOOMINGTON IN
47403-5000
US

IV. Provider business mailing address

482 S LANDMARK AVE
BLOOMINGTON IN
47403-5000
US

V. Phone/Fax

Practice location:
  • Phone: 812-333-8474
  • Fax:
Mailing address:
  • Phone: 812-333-8474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042983A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20042983A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: