Provider Demographics
NPI:1922001973
Name:ANDERSON-KRULL, TERESA MARY (MSW LICSW)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:MARY
Last Name:ANDERSON-KRULL
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007-2919
Mailing Address - Country:US
Mailing Address - Phone:507-377-0107
Mailing Address - Fax:507-377-1194
Practice Address - Street 1:216 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-2919
Practice Address - Country:US
Practice Address - Phone:507-377-0107
Practice Address - Fax:507-377-1194
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN103903OtherUCARE
MN131L4ANOtherBLUE SHIELD
MN025801OtherVMC BEHAVIORAL HEALTHCARE
MNHP40008OtherHEALTH PARTNERS