Provider Demographics
NPI:1952463879
Name:CRAUN, ANN MICHELE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:MICHELE
Last Name:CRAUN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4219 E 410 N
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442
Mailing Address - Country:US
Mailing Address - Phone:208-745-0285
Mailing Address - Fax:
Practice Address - Street 1:4219 E 410 N
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-5518
Practice Address - Country:US
Practice Address - Phone:208-745-0285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0371103T00000X
IDPSY-202650103T00000X
COPSY1097103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV81-0574867OtherTAX TD
NV81-0574867OtherTAX TD