1073820106 NPI number — MRS. JENNIFER M KRAUSE MA, CCC-A

Table of content: MRS. JENNIFER M KRAUSE MA, CCC-A (NPI 1073820106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073820106 NPI number — MRS. JENNIFER M KRAUSE MA, CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRAUSE
Provider First Name:
JENNIFER
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, CCC-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DONNELLY
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, CCC-A
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073820106
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2680 S VAL VISTA DR
Provider Second Line Business Mailing Address:
BLDG 13, UNIT 175
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85295-2152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-784-0110
Provider Business Mailing Address Fax Number:
480-784-0220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2680 S VAL VISTA DR
Provider Second Line Business Practice Location Address:
BLDG 13, UNIT 175
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85295-2152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-784-0110
Provider Business Practice Location Address Fax Number:
480-784-0220
Provider Enumeration Date:
09/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  DA4551 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1073820106 . This is a "MEDICARE NPI" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com