Provider Demographics
NPI:1669510830
Name:KRAUSE, CHRISTINE NOEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:NOEL
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6221 NE FREMONT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-4437
Mailing Address - Country:US
Mailing Address - Phone:971-207-7371
Mailing Address - Fax:503-289-2317
Practice Address - Street 1:6221 NE FREMONT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-4437
Practice Address - Country:US
Practice Address - Phone:971-207-7371
Practice Address - Fax:503-289-2317
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1458103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR268705Medicaid