Provider Demographics
NPI:1205041480
Name:KRAEGEL, IRENE B (PSYD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:B
Last Name:KRAEGEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 W CHURCH ST
Mailing Address - Street 2:PO BOX 332
Mailing Address - City:MILAN
Mailing Address - State:OH
Mailing Address - Zip Code:44846-9368
Mailing Address - Country:US
Mailing Address - Phone:419-499-8121
Mailing Address - Fax:
Practice Address - Street 1:17 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:OH
Practice Address - Zip Code:44846-9368
Practice Address - Country:US
Practice Address - Phone:419-499-8121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6132103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical