Individual
DEBRA L CRUICKSHANK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW LCSW CSW-G
Contact information
Practice address
2919 CROSSING CT, SUITE 6, CHAMPAIGN, IL 61822-5903
(217) 727-8112
(217) 531-2788
Mailing address
2212 S ANDERSON ST, URBANA, IL 61801-6755
(217) 278-1122
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IL787003
MEDICARE PTAN INDIVIDUAL
IL
Enumeration date
01/31/2008
Last updated
02/19/2014
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