Provider Demographics
NPI:1811628407
Name:KROESCH, KAYLA (CRC)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:KROESCH
Suffix:
Gender:F
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 WINGO LN APT 1
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-4652
Mailing Address - Country:US
Mailing Address - Phone:815-403-6694
Mailing Address - Fax:
Practice Address - Street 1:521 E 86TH AVE STE H
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6236
Practice Address - Country:US
Practice Address - Phone:219-323-3311
Practice Address - Fax:888-981-2760
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Multi-Specialty