Provider Demographics
NPI:1821124199
Name:KRAUSE, PAMELA KILLIAN
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:KILLIAN
Last Name:KRAUSE
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 1:1021 NORTH WATERFORD WAY
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050
Mailing Address - Country:US
Mailing Address - Phone:717-732-6055
Mailing Address - Fax:
Practice Address - Street 1:1021 N WATERFORD WAY
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-7632
Practice Address - Country:US
Practice Address - Phone:717-732-6055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW-012014101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health