Provider Demographics
NPI:1700042801
Name:KRULL, ANNA (PSYD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:KRULL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-2424
Mailing Address - Country:US
Mailing Address - Phone:763-421-5535
Mailing Address - Fax:763-433-0226
Practice Address - Street 1:7525 MITCHELL RD STE 100
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-1900
Practice Address - Country:US
Practice Address - Phone:952-224-2282
Practice Address - Fax:952-224-2284
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00350101YP2500X
MNLP6596103T00000X
MN2550106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist