Healthcare Provider Details

I. General information

NPI: 1558663575
Provider Name (Legal Business Name): MRS. JOANN D KRIEGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2010
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 BROADWAY
BUFFALO NY
14212-1501
US

IV. Provider business mailing address

1526 WALDEN AVENUE SUITE 400
CHEEKTOWAGA NY
14225-4985
US

V. Phone/Fax

Practice location:
  • Phone: 716-896-7350
  • Fax: 716-896-7717
Mailing address:
  • Phone: 716-895-6700
  • Fax: 716-895-0436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005528
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: