Provider Demographics
NPI:1326510223
Name:KRAUTMAN, PATRICIA (MS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:KRAUTMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 DEALE RD
Mailing Address - Street 2:
Mailing Address - City:TRACYS LANDING
Mailing Address - State:MD
Mailing Address - Zip Code:20779-9736
Mailing Address - Country:US
Mailing Address - Phone:410-222-1633
Mailing Address - Fax:
Practice Address - Street 1:20 DEALE RD
Practice Address - Street 2:
Practice Address - City:TRACYS LANDING
Practice Address - State:MD
Practice Address - Zip Code:20779-9736
Practice Address - Country:US
Practice Address - Phone:410-222-1633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05421235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5831Medicaid