Provider Demographics
NPI:1225687460
Name:KRUSE, CLARICE ELIZABETH
Entity Type:Individual
Prefix:
First Name:CLARICE
Middle Name:ELIZABETH
Last Name:KRUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4483 W. BAY CITY FORSETVILLE RD.
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48767
Mailing Address - Country:US
Mailing Address - Phone:989-528-9343
Mailing Address - Fax:
Practice Address - Street 1:4483 W. BAY CITY FORSETVILLE RD.
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:MI
Practice Address - Zip Code:48767
Practice Address - Country:US
Practice Address - Phone:989-528-9343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst