Provider Demographics
NPI:1528397510
Name:RAUCH, KRISTEN (MS,CGC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:RAUCH
Suffix:
Gender:F
Credentials:MS,CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3980 JOHN R ST
Mailing Address - Street 2:BOX 160
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2018
Mailing Address - Country:US
Mailing Address - Phone:313-993-4431
Mailing Address - Fax:313-993-4444
Practice Address - Street 1:3980 JOHN R ST
Practice Address - Street 2:BOX 160
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2018
Practice Address - Country:US
Practice Address - Phone:313-993-4431
Practice Address - Fax:313-993-4444
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS