Provider Demographics
NPI:1881352946
Name:KROMMINGA, KOURTNEY REBECCA
Entity type:Individual
Prefix:DR
First Name:KOURTNEY
Middle Name:REBECCA
Last Name:KROMMINGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KOURTNEY
Other - Middle Name:REBECCA
Other - Last Name:MCNALLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2917 N ATHENIAN AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67204-4717
Mailing Address - Country:US
Mailing Address - Phone:507-251-5852
Mailing Address - Fax:
Practice Address - Street 1:4068 MOUNT ROYAL BLVD STE 110
Practice Address - Street 2:
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101-2951
Practice Address - Country:US
Practice Address - Phone:412-212-6468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist