MEDICARE: DR. KATHRYN MILLER KROGH PHD

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
1	103TC0700X	Clinical Psychologist	0810001718	VA

General Provider Information

NPI Number	:	1669474177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHRYN MILLER KROGH PHD

Provider Business Mailing Address
First Line	:	3101 N NOTTINGHAM ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22207-1363
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3101 N NOTTINGHAM ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22207-1363
Country	:	US
Telephone Number	:	703-538-6616
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	07/08/2007

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