Provider Demographics
NPI:1467965293
Name:KRASKOUSKAS, KATHLEEN DAWN (CMT, LDT, NFB, MC-IM)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:DAWN
Last Name:KRASKOUSKAS
Suffix:
Gender:F
Credentials:CMT, LDT, NFB, MC-IM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 W JULIAN ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-2338
Mailing Address - Country:US
Mailing Address - Phone:408-279-1122
Mailing Address - Fax:408-326-2785
Practice Address - Street 1:541 W JULIAN ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-2338
Practice Address - Country:US
Practice Address - Phone:408-279-1122
Practice Address - Fax:408-326-2785
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist