Provider Demographics
NPI:1912987579
Name:KREUSSER, WILLIAM RANDALL (PSYD LP)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RANDALL
Last Name:KREUSSER
Suffix:
Gender:M
Credentials:PSYD LP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1875 NORTHWESTERN AVE S
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-7534
Mailing Address - Country:US
Mailing Address - Phone:651-439-4840
Mailing Address - Fax:651-439-4894
Practice Address - Street 1:1099 HELMO AVE N
Practice Address - Street 2:SUITE 250
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-6033
Practice Address - Country:US
Practice Address - Phone:651-439-4840
Practice Address - Fax:651-439-4894
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP4143103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical