Provider Demographics
NPI:1558588715
Name:KRALL, SHIRLEY G (MS, EIS)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:G
Last Name:KRALL
Suffix:
Gender:F
Credentials:MS, EIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WATSEKA
Mailing Address - State:IL
Mailing Address - Zip Code:60970-1627
Mailing Address - Country:US
Mailing Address - Phone:815-432-3445
Mailing Address - Fax:
Practice Address - Street 1:700 E ELM ST
Practice Address - Street 2:
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970-1400
Practice Address - Country:US
Practice Address - Phone:815-432-5288
Practice Address - Fax:814-432-5288
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILSK14410200P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist