Provider Demographics
NPI:1609183854
Name:KENT KROUSE, STEPHANIE M (MS, CNIM)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:M
Last Name:KENT KROUSE
Suffix:
Gender:F
Credentials:MS, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5460 WARD RD. #300
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1800
Mailing Address - Country:US
Mailing Address - Phone:303-351-7060
Mailing Address - Fax:303-395-0826
Practice Address - Street 1:5460 WARD RD. #300
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-1800
Practice Address - Country:US
Practice Address - Phone:303-351-7060
Practice Address - Fax:303-395-0826
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZE0600X
CO246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic