Provider Demographics
NPI:1487675229
Name:KRAUFT, VIRGINIA (EDD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:KRAUFT
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 RAINBOW RD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8821
Mailing Address - Country:US
Mailing Address - Phone:479-254-1144
Mailing Address - Fax:479-254-1099
Practice Address - Street 1:1601 RAINBOW RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8821
Practice Address - Country:US
Practice Address - Phone:479-254-1144
Practice Address - Fax:479-254-1099
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR74-6P103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR117061719Medicaid
AR59284Medicare PIN