Provider Demographics
NPI:1376296020
Name:KROHA, KYLE JANE (MSW)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:JANE
Last Name:KROHA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 162
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:IL
Mailing Address - Zip Code:60957-0162
Mailing Address - Country:US
Mailing Address - Phone:217-379-4302
Mailing Address - Fax:217-817-0379
Practice Address - Street 1:1510 W OTTAWA RD
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:IL
Practice Address - Zip Code:60957-4090
Practice Address - Country:US
Practice Address - Phone:217-379-4302
Practice Address - Fax:217-817-0379
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker