Provider Demographics
NPI:1639320997
Name:KROLL, KATHLEEN A
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:A
Last Name:KROLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36180 HEMLOCK ST W
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16438-4306
Mailing Address - Country:US
Mailing Address - Phone:814-860-0501
Mailing Address - Fax:
Practice Address - Street 1:36180 HEMLOCK ST W
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:PA
Practice Address - Zip Code:16438-4306
Practice Address - Country:US
Practice Address - Phone:814-860-0501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057003028174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist