Provider Demographics
NPI:1841322468
Name:KRUKOW, JOYCE K (LISW)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:K
Last Name:KRUKOW
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 6TH SW
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-4815
Mailing Address - Country:US
Mailing Address - Phone:641-423-0711
Mailing Address - Fax:641-423-0713
Practice Address - Street 1:1327 6TH SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-4815
Practice Address - Country:US
Practice Address - Phone:641-423-0711
Practice Address - Fax:641-423-0713
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00889104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA22068OtherMIDLANDS CHOICE
IA0249656Medicaid
IA0249656Medicaid
IAI4692Medicare PIN