Physician Compare National (NPI:1962690412)

HEALTHCARE PROVIDER: KELLY C KREUTZ LICSW

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1962690412
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6608115340
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190225002386
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KREUTZ
	Individual professional last name
Provider First Name	KELLY
	Individual professional first name
Provider Middle Name	C
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2006
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	9825 SANDIFUR PKWY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE D
	Group Practice or individual's line 2 address
City	PASCO
	Group Practice or individual's city
State	WA
	Group Practice or individual's state
Zip Code	993016738
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y