Sandra Johnston Kruse, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Practice address

336 Gundersen Dr Ste B
Outreach Community Counseling Center
Carol Stream, IL 60188-2403

Phone

(630) 871-2100

Fax

(630) 588-0824

NPI assigned

Oct 11, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Dec 2, 2023 through Dec 2, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Outreach Community Ministries Inc

  dba Outreach Community Counseling Center in Carol Stream

  • Adolescent and Children Mental Health Clinic/Center
  • Wheaton, IL
  • NPI 1255443669
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192060800000",
    "number": "1144418500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "336 GUNDERSEN DR STE B",
            "address_2": "OUTREACH COMMUNITY COUNSELING CENTER",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601882403",
            "telephone_number": "630-871-2100",
            "fax_number": "630-588-0824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "336 GUNDERSEN DR STE B",
            "address_2": "OUTREACH COMMUNITY COUNSELING CENTER",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601882403",
            "telephone_number": "630-871-2100",
            "fax_number": "630-588-0824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUSE",
        "first_name": "SANDRA",
        "middle_name": "JOHNSTON",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-11",
        "last_updated": "2007-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barbara C Kopchak
• Mark J Kortenhoeven, PT
• Ashley Marie Kranz, LCSW
• Kellie Krefft, M.A., CCC-SLP
• Alexa Krueger
• Stephanie Kuehn
• Lineta Kundrotiene
• Joseph Anthony Lagattuta Jr., MD
• Connie Lam
• Samantha Lanagan, BCBA

• Clinical Psychologist in Carol Stream, IL
• Providers in Carol Stream, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.