Provider Demographics
NPI:1952311896
Name:KRATZENBERG, REBECKAH SUE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:REBECKAH
Middle Name:SUE
Last Name:KRATZENBERG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:REBECKAH
Other - Middle Name:CARTER
Other - Last Name:KRATZENBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:2948 E US HIGHWAY 60
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-7946
Mailing Address - Country:US
Mailing Address - Phone:606-474-8889
Mailing Address - Fax:
Practice Address - Street 1:1101 VETERANS DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-2235
Practice Address - Country:US
Practice Address - Phone:859-475-7273
Practice Address - Fax:606-784-3011
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-3463104100000X
WVDP009427651041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker