Healthcare Provider Details

I. General information

NPI: 1104046879
Provider Name (Legal Business Name): GORDON KRAINEN PH.D., CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 CATHERINE ST
ANN ARBOR MI
48109-2054
US

IV. Provider business mailing address

6235 MISSION DR
WEST BLOOMFIELD MI
48324-1396
US

V. Phone/Fax

Practice location:
  • Phone: 734-764-8440
  • Fax:
Mailing address:
  • Phone: 248-366-1999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: