Provider Demographics
NPI:1184026486
Name:KRUPKO, ALLISON ANNE (EDS)
Entity Type:Individual
Prefix:MISS
First Name:ALLISON
Middle Name:ANNE
Last Name:KRUPKO
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14277 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:OH
Mailing Address - Zip Code:44609-9504
Mailing Address - Country:US
Mailing Address - Phone:330-938-4490
Mailing Address - Fax:
Practice Address - Street 1:14277 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:OH
Practice Address - Zip Code:44609-9504
Practice Address - Country:US
Practice Address - Phone:330-938-4490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3131275103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool