NPI 1609410596

Justin S Kroll

Practitioner Prevention Professional Port Huron, MI

Practice location

Address: 1902 13th St, Port Huron, MI 48060-6238
Phone: (810) 300-8536

Registered specialties

Prevention Professional Primary

Other Service Providers Taxonomy 405300000X Licence 1863 (CT)

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Registry record

NPI: 1609410596
Entity type: Individual
Sex (as registered): Male
NPI issued: 4 Nov 2019
Record last updated: 10 Dec 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.