Provider Demographics
NPI:1144418500
Name:KRUSE, SANDRA JOHNSTON (PSYD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:JOHNSTON
Last Name:KRUSE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 GUNDERSEN DR STE B
Mailing Address - Street 2:OUTREACH COMMUNITY COUNSELING CENTER
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2403
Mailing Address - Country:US
Mailing Address - Phone:630-871-2100
Mailing Address - Fax:630-588-0824
Practice Address - Street 1:336 GUNDERSEN DR STE B
Practice Address - Street 2:OUTREACH COMMUNITY COUNSELING CENTER
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2403
Practice Address - Country:US
Practice Address - Phone:630-871-2100
Practice Address - Fax:630-588-0824
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical