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NPI Code Detail

MEDICARE: KATHLINE CRUZ

MEDICARE: KATHLINE CRUZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorE.0900541OH

General Provider Information

NPI Number : 1558217976
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLINE CRUZ
Provider Business Mailing Address
First Line : PO BOX 11167
Second Line :
City : FORT WAYNE
State : IN
Zip : 46856-1167
Country : US
Telephone Number : 574-546-1900
Fax Number : 574-546-1999
Provider Business Practice Location Address
First Line : 21 E STATE ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43215-4281
Country : US
Telephone Number : 574-546-1900
Fax Number : 574-546-1999
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2026
Last Update Date : 03/09/2026

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Directions to “ KATHLINE CRUZ ” Practice Location

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