Provider Demographics
NPI:1376641605
Name:KRUMHOLZ, ALLYN (LP)
Entity Type:Individual
Prefix:MR
First Name:ALLYN
Middle Name:
Last Name:KRUMHOLZ
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 E 4TH ST
Mailing Address - Street 2:SUITE 19
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3507
Mailing Address - Country:US
Mailing Address - Phone:507-458-6538
Mailing Address - Fax:507-454-4420
Practice Address - Street 1:51 E 4TH ST
Practice Address - Street 2:SUITE 19
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3507
Practice Address - Country:US
Practice Address - Phone:507-458-6538
Practice Address - Fax:507-454-4420
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP #1603103T00000X, 103TC1900X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6270799OtherMEDICA/UBH PROVIDER#
MN106962OtherUCARE MINNESOTA #
MN3H088KROtherBCBS GROUP #
MN3H089KROtherBCBS INDIVIDUAL PROVIDER#
MN6270799OtherMEDICA/UBH PROVIDER#