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General NPI Number Information
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NPI Number | 1588971758
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Entity Type | Individual
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Provider Name | ALLISON T KRUTUL PSYD
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Gender | Female
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Dates
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Enumeration Date | 09/08/2010
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 1701 CURTIS RD PSYCHOLOGY
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City | CHAMPAIGN
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State | IL
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Zip | 61822-9678
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Country | US
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Telephone | 217-365-6206
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Fax | 217-326-4003
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Provider Business Mailing Address
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Address Line | PO BOX 6002
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City | URBANA
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State | IL
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Zip | 61803-6002
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Country | US
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Telephone | 217-326-8630
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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