Provider Demographics
NPI:1275318982
Name:KRALL, RANDALL JAMES
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:JAMES
Last Name:KRALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 E FARWELL RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-9579
Mailing Address - Country:US
Mailing Address - Phone:509-995-5703
Mailing Address - Fax:
Practice Address - Street 1:622 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2202
Practice Address - Country:US
Practice Address - Phone:509-995-5703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)