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NPI Code Detail

MEDICARE: LISA KRAUS

MEDICARE: LISA KRAUS
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1669015822
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA KRAUS
Provider Business Mailing Address
First Line : 12800 S NEWPORT DR
Second Line :
City : PALOS PARK
State : IL
Zip : 60464-2603
Country : US
Telephone Number : 708-743-7473
Fax Number :
Provider Business Practice Location Address
First Line : 3301 W 111TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60655-2715
Country : US
Telephone Number : 312-315-5210
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2019
Last Update Date : 10/21/2019

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Directions to “ LISA KRAUS ” Practice Location

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