Healthcare Provider Details

I. General information

NPI: 1841703345
Provider Name (Legal Business Name): ELIZABETH ANNE KRICKHAHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W STADIUM AVE APT 3
LAFAYETTE IN
47906-2683
US

IV. Provider business mailing address

PO BOX 27303
ALBUQUERQUE NM
87125-7303
US

V. Phone/Fax

Practice location:
  • Phone: 505-205-7439
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number10017
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: