Provider Demographics
NPI:1013530542
Name:KRANTZ, MACKAULIE (MS, CRC)
Entity Type:Individual
Prefix:
First Name:MACKAULIE
Middle Name:
Last Name:KRANTZ
Suffix:
Gender:F
Credentials:MS, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2495 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1984
Mailing Address - Country:US
Mailing Address - Phone:651-760-3109
Mailing Address - Fax:651-967-9417
Practice Address - Street 1:2495 MAPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1984
Practice Address - Country:US
Practice Address - Phone:651-760-3109
Practice Address - Fax:651-967-9417
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00383038225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor