Healthcare Provider Details

I. General information

NPI: 1053951376
Provider Name (Legal Business Name): GRACE KRAUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 BLAKE ST
DENVER CO
80205-2406
US

IV. Provider business mailing address

1063 QUAKER ST
GOLDEN CO
80401-2998
US

V. Phone/Fax

Practice location:
  • Phone: 720-419-2187
  • Fax:
Mailing address:
  • Phone: 913-488-2810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-56949
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: