Provider Demographics
NPI:1073820106
Name:KRAUSE, JENNIFER M (MA, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:M
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:DONNELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-A
Mailing Address - Street 1:2680 S VAL VISTA DR
Mailing Address - Street 2:BLDG 13, UNIT 175
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-2152
Mailing Address - Country:US
Mailing Address - Phone:480-784-0110
Mailing Address - Fax:480-784-0220
Practice Address - Street 1:2680 S VAL VISTA DR
Practice Address - Street 2:BLDG 13, UNIT 175
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-2152
Practice Address - Country:US
Practice Address - Phone:480-784-0110
Practice Address - Fax:480-784-0220
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA4551231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1073820106OtherMEDICARE NPI
1073820106OtherMEDICARE NPI