Active NPI
Theresa Anne Kruczek, PH.D.
- Psychologist
- Muncie, IN
National Provider Identifier
1801112677
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 20041547A
- Practice address
- 100 N Tillotson Ave
Muncie, IN 47304-3987 - Phone
- (765) 729-0152
- NPI assigned
- Apr 19, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 20041547A | IN | Primary |
Addresses
Primary practice location
100 N Tillotson Ave
Muncie, IN 47304-3987
Mailing address
4105 W Jackson St
Muncie, IN 47304-3612
Phone (765) 729-0152
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20041547A | IN | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1271635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1271635200000",
"number": "1801112677",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4105 W JACKSON ST",
"city": "MUNCIE",
"state": "IN",
"postal_code": "473043612",
"telephone_number": "765-729-0152"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 N TILLOTSON AVE",
"city": "MUNCIE",
"state": "IN",
"postal_code": "473043987",
"telephone_number": "765-729-0152"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUCZEK",
"first_name": "THERESA",
"middle_name": "ANNE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-04-19",
"last_updated": "2010-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "IN",
"license": "20041547A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Muncie, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.