Provider Demographics
NPI:1730469339
Name:KRAUTHEIM, JILLIAN S
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:S
Last Name:KRAUTHEIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 DAHLIA CT N
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-5531
Mailing Address - Country:US
Mailing Address - Phone:813-476-4432
Mailing Address - Fax:
Practice Address - Street 1:9 DAHLIA CT N
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34446-5531
Practice Address - Country:US
Practice Address - Phone:813-476-4432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst