Provider Demographics
NPI:1093864993
Name:KRAUSE, BYRON J (MHA MSCCCSLP)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:J
Last Name:KRAUSE
Suffix:
Gender:M
Credentials:MHA MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 BUTLER AVENUE
Mailing Address - Street 2:PARK VIEW PLEASANT ACRES ATTN SPEECH THERAPY
Mailing Address - City:WINNEBAGO
Mailing Address - State:WI
Mailing Address - Zip Code:54985
Mailing Address - Country:US
Mailing Address - Phone:920-235-5100
Mailing Address - Fax:920-233-7352
Practice Address - Street 1:725 BUTLER AVE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54985
Practice Address - Country:US
Practice Address - Phone:920-235-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1636154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42790400Medicaid