Portage Psychology PA

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

PORTAGE PSYCHOLOGY PA

Practice address

10125 Crosstown Cir Ste 110
Eden Prairie, MN 55344-3316

Phone

(612) 688-5933

Fax

(612) 500-4607

NPI assigned

May 4, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Anna Krull, PSYD, LPNPI 1700042801

Title

Vice-President

Phone

(612) 986-3333

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Anna Krull, PSYD

  • Psychologist
  • Eden Prairie, MN
  • NPI 1700042801
  NPD Authorized official

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

{
    "created_epoch": "1651622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651622400000",
    "number": "1245975010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10125 CROSSTOWN CIR STE 110",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443316",
            "telephone_number": "612-688-5933",
            "fax_number": "612-500-4607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10125 CROSSTOWN CIR STE 110",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443316",
            "telephone_number": "612-688-5933",
            "fax_number": "612-500-4607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTAGE PSYCHOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-04",
        "last_updated": "2022-05-04",
        "certification_date": "2022-05-04",
        "status": "A",
        "authorized_official_last_name": "KRULL",
        "authorized_official_first_name": "ANNA",
        "authorized_official_title_or_position": "VICE-PRESIDENT",
        "authorized_official_telephone_number": "612-986-3333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD, LP"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Eden Prairie, MN
• Providers in Eden Prairie, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.