Provider Demographics
NPI:1376014613
Name:KRAUS, PAMELA JEAN (LCPC, MBA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:KRAUS
Suffix:
Gender:F
Credentials:LCPC, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 W JACKSON BLVD STE 440
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-3457
Mailing Address - Country:US
Mailing Address - Phone:847-224-1647
Mailing Address - Fax:
Practice Address - Street 1:53 W JACKSON BLVD STE 440
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3457
Practice Address - Country:US
Practice Address - Phone:847-224-1647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.014405101YP2500X
IL180.013376101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional