Provider Demographics
NPI:1568764900
Name:KRUMWIEDE, LEANN ELIZABETH (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LEANN
Middle Name:ELIZABETH
Last Name:KRUMWIEDE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:LEANN
Other - Middle Name:ELIZABETH
Other - Last Name:KRUMWIEDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:2714 CENTER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-7268
Mailing Address - Country:US
Mailing Address - Phone:712-336-3500
Mailing Address - Fax:712-336-3505
Practice Address - Street 1:2714 CENTER LAKE DR
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-7268
Practice Address - Country:US
Practice Address - Phone:712-336-3500
Practice Address - Fax:712-336-3505
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000095174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist