1922001973 NPI number — MS. TERESA MARY ANDERSON-KRULL MSW LICSW

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	ANDERSON-KRULL
Provider First Name	:	TERESA
Provider Middle Name	:	MARY
Provider Name Prefix Text	:	MS.
Provider Name Suffix Text	:
Provider Credential Text	:	MSW LICSW
Provider Gender Code	:	F

Provider Other Organization Name	:
Provider Other Organization Name Type Code	:
Provider Other Last Name	:
Provider Other First Name	:
Provider Other Middle Name	:
Provider Other Name Prefix Text	:
Provider Other Name Suffix Text	:
Provider Other Credential Text	:
Provider Other Last Name Type Code	:

NPI Number	:	1922001973
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	07/08/2007
NPI Deactivation Reason Code	:
NPI Deactivation Date	:
NPI Reactivation Date	:

Provider First Line Business Mailing Address	:	216 E MAIN ST
Provider Second Line Business Mailing Address	:
Provider Business Mailing Address City Name	:	ALBERT LEA
Provider Business Mailing Address State Name	:	MN
Provider Business Mailing Address Postal Code	:	560072919
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	5073770107
Provider Business Mailing Address Fax Number	:	5073771194

Provider First Line Business Practice Location Address	:	216 E MAIN ST
Provider Second Line Business Practice Location Address	:
Provider Business Practice Location Address City Name	:	ALBERT LEA
Provider Business Practice Location Address State Name	:	MN
Provider Business Practice Location Address Postal Code	:	560072919
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	5073770107
Provider Business Practice Location Address Fax Number	:	5073771194
Provider Enumeration Date	:	05/23/2005

Authorized Official Last Name	:
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• Taxonomy code: 1041C0700X , with the licence number:  2581 , registered in the state of MN .

• Identifier: HP40008 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "".
• Identifier: 103903 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "".
• Identifier: 025801 . This is a "VMC BEHAVIORAL HEALTHCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "".
• Identifier: 131L4AN . This is a "BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "".