Provider Demographics
NPI:1265124325
Name:KROLAK, TEANA ANN MARIE
Entity type:Individual
Prefix:
First Name:TEANA
Middle Name:ANN MARIE
Last Name:KROLAK
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 1:2373 NE 106TH AVE APT 1114
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-8245
Mailing Address - Country:US
Mailing Address - Phone:952-999-1712
Mailing Address - Fax:
Practice Address - Street 1:32 NE 11TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3001
Practice Address - Country:US
Practice Address - Phone:503-542-7635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor