MEDICARE: MARILYN R KRAAR LCSW

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	637-123	WI

General Provider Information

NPI Number	:	1851502355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN R KRAAR LCSW

Provider Business Mailing Address
First Line	:	4606 N OAKLAND AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-1231
Country	:	US
Telephone Number	:	414-332-3231
Fax Number	:	414-771-9543

Provider Business Practice Location Address
First Line	:	4606 N OAKLAND AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-1231
Country	:	US
Telephone Number	:	414-332-3231
Fax Number	:	414-771-9543

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

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	07/08/2007

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