MEDICARE: RICK J KRAUSE MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	1027	OK

General Provider Information

NPI Number	:	1639237829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICK J KRAUSE MSW

Provider Business Mailing Address
First Line	:	4435 NW 36TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2704
Country	:	US
Telephone Number	:	405-948-8504
Fax Number	:	405-848-0167

Provider Business Practice Location Address
First Line	:	4435 NW 36TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2704
Country	:	US
Telephone Number	:	405-948-8504
Fax Number	:	405-848-0167

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/08/2007

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