Provider Demographics
NPI:1003156746
Name:KRAUS, ALISHA R
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:R
Last Name:KRAUS
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 1:1930 N PROSPECT AVE
Mailing Address - Street 2:APT 51
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1491
Mailing Address - Country:US
Mailing Address - Phone:920-948-3194
Mailing Address - Fax:
Practice Address - Street 1:9501 W WATERTOWN PLANK RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3552
Practice Address - Country:US
Practice Address - Phone:414-257-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-17
Last Update Date:2013-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI128847-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker