Organization
PORTAGE PSYCHOLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANNA KRULL PSYD, LP (VICE-PRESIDENT)
(612) 986-3333
Entity
Organization
Contact information
Practice address
10125 CROSSTOWN CIR STE 110, EDEN PRAIRIE, MN 55344-3316
(612) 688-5933
(612) 500-4607
Mailing address
10125 CROSSTOWN CIR STE 110, EDEN PRAIRIE, MN 55344-3316
(612) 688-5933
(612) 500-4607
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
05/04/2022
Last updated
05/04/2022
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