Provider Demographics
NPI:1851890099
Name:KRAYENHAGEN, BETH MARIE (MSW)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:MARIE
Last Name:KRAYENHAGEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 5TH ST STE 270
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2933
Mailing Address - Country:US
Mailing Address - Phone:319-804-9312
Mailing Address - Fax:319-449-3845
Practice Address - Street 1:1150 5TH ST STE 270
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2933
Practice Address - Country:US
Practice Address - Phone:319-804-9312
Practice Address - Fax:319-449-3845
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA083297101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional