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

Table of content: MS. TERESA MARY ANDERSON-KRULL MSW LICSW (NPI 1922001973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922001973 NPI number — MS. TERESA MARY ANDERSON-KRULL MSW LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last 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's Other Name Information

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 Information

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's Business Mailing Address

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:
56007-2919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-377-0107
Provider Business Mailing Address Fax Number:
507-377-1194

Provider's Practice Location Mailing Address

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:
56007-2919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-377-0107
Provider Business Practice Location Address Fax Number:
507-377-1194
Provider Enumeration Date:
05/23/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  2581 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

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