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General NPI Number Information
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NPI Number | 1043753767
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Entity Type | Individual
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Provider Name | BRIAN JOHN KRUZELL LLMSW
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Gender | Male
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Dates
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Enumeration Date | 11/29/2016
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Last Update Date | 06/08/2018
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Provider Practice Location Address
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Address Line | 400 JOHNSON ST
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City | ALPENA
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State | MI
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Zip | 49707-1434
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Country | US
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Telephone | 989-356-2161
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Fax |
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Provider Business Mailing Address
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Address Line | 713 2 5TH AVE APT B
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City | ALPENA
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State | MI
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Zip | 49707
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Country | US
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Telephone | 989-313-6461
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801102548
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License Number State | MI
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