Provider Demographics
NPI:1811149040
Name:KRAUSE, ELIZABETH PRUDA (PPC)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:PRUDA
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:PPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MAIN ST
Mailing Address - Street 2:SUITE # 6
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3151
Mailing Address - Country:US
Mailing Address - Phone:307-332-4515
Mailing Address - Fax:
Practice Address - Street 1:14 GREAT PLAINS ROAD
Practice Address - Street 2:
Practice Address - City:ARAPAHOE
Practice Address - State:WY
Practice Address - Zip Code:82510
Practice Address - Country:US
Practice Address - Phone:307-856-9281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-442101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY144908700Medicaid