Provider Demographics
NPI:1396375721
Name:KRUTEK, WOODLI (LLMSW)
Entity Type:Individual
Prefix:
First Name:WOODLI
Middle Name:
Last Name:KRUTEK
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1464 ASTOR AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6144
Mailing Address - Country:US
Mailing Address - Phone:828-242-2906
Mailing Address - Fax:
Practice Address - Street 1:1464 ASTOR AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6144
Practice Address - Country:US
Practice Address - Phone:828-242-2906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011063271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical