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General NPI Number Information
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NPI Number | 1538707138
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Entity Type | Individual
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Provider Name | KAYLEE KRUZAN
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Gender | Female
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Dates
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Enumeration Date | 12/13/2019
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 4411 N RAVENSWOOD AVE STE 250
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City | CHICAGO
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State | IL
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Zip | 60640-5802
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Country | US
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Telephone | 773-892-1933
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Fax |
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Provider Business Mailing Address
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Address Line | 2620 INDUSTRY WAY
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City | LYNWOOD
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State | CA
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Zip | 90262-4024
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Country | US
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Telephone | 323-242-5000
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.027672
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License Number State | IL
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