Individual
DANA KRUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT -17-34424
Contact information
Practice address
4422 MILA AVE, ROCKFORD, IL 61101-4942
(815) 904-2474
Mailing address
4422 MILA AVE, ROCKFORD, IL 61101-4942
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
17-34424
IL
Other
Enumeration date
05/15/2018
Last updated
05/15/2018
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