Individual
MARLENE KRUPA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
2701 W 68TH STREET, CHICAGO, IL 60629
(708) 991-9002
(708) 991-9003
Mailing address
13360 AVENUE M, CHICAGO, IL 60633
(773) 646-2099
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
71006290
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01632081
BLUE CROSS & BLUE SHIELD
IL
Enumeration date
10/03/2006
Last updated
07/08/2007
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