Provider Demographics
NPI:1801964267
Name:KRAUSE, MIRIAM
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:KRAUSE
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 1:812 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5844
Mailing Address - Country:US
Mailing Address - Phone:763-412-9315
Mailing Address - Fax:
Practice Address - Street 1:WALTER REED ARMY MEDICAL CTR
Practice Address - Street 2:6900 GEORGIA AVE, NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0001
Practice Address - Country:US
Practice Address - Phone:202-782-8558
Practice Address - Fax:202-782-9228
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8122235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist