Provider Demographics
NPI:1558129080
Name:KROUSE, REBECCA (HIS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:KROUSE
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:WALDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1205 S ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-1645
Mailing Address - Country:US
Mailing Address - Phone:660-473-2875
Mailing Address - Fax:
Practice Address - Street 1:3242 S NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7303
Practice Address - Country:US
Practice Address - Phone:417-512-5027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014043014237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist