Provider Demographics
NPI:1710595749
Name:KRAUTER, IAN SCOTT (LICSW)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:SCOTT
Last Name:KRAUTER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14820 64TH ST NE UNIT A
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-9747
Mailing Address - Country:US
Mailing Address - Phone:360-599-4765
Mailing Address - Fax:
Practice Address - Street 1:14820 64TH ST NE UNIT A
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-9747
Practice Address - Country:US
Practice Address - Phone:360-599-4765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW608957311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical