Provider Demographics
NPI:1275083768
Name:KRUG, HEIDI JO (PSY D)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:JO
Last Name:KRUG
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 MCKINLEY AVE
Mailing Address - Street 2:SUITEC
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-2733
Mailing Address - Country:US
Mailing Address - Phone:574-222-2466
Mailing Address - Fax:574-222-2468
Practice Address - Street 1:2955 MCKINLEY AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-2733
Practice Address - Country:US
Practice Address - Phone:574-222-2466
Practice Address - Fax:574-222-2468
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist