Provider Demographics
NPI:1821680950
Name:KRAUSE, OWEN ALTON
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:ALTON
Last Name:KRAUSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2038 W 8970 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9373
Mailing Address - Country:US
Mailing Address - Phone:732-632-7898
Mailing Address - Fax:
Practice Address - Street 1:515 S 700 E
Practice Address - Street 2:2A
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102
Practice Address - Country:US
Practice Address - Phone:732-632-7898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT213008386OtherDRIVERS LICENSE