Healthcare Provider Details

I. General information

NPI: 1316371024
Provider Name (Legal Business Name): KIMBERLY KRAUS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD PV05
PORTLAND OR
97239-3011
US

IV. Provider business mailing address

3181 SW SAM JACKSON PARK RD PV05
PORTLAND OR
97239-3011
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-8788
  • Fax: 503-418-2208
Mailing address:
  • Phone: 503-494-8788
  • Fax: 503-418-2208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2395
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: