Healthcare Provider Details

I. General information

NPI: 1366997710
Provider Name (Legal Business Name): JENNIFER NICOLE CRAUGH MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1537 HERITAGE BLVD
WEST SALEM WI
54669-9404
US

IV. Provider business mailing address

860 MILL ST N SUITE #2
WEST SALEM WI
54669-2213
US

V. Phone/Fax

Practice location:
  • Phone: 608-799-4860
  • Fax: 414-377-3353
Mailing address:
  • Phone: 608-799-4860
  • Fax: 414-377-3353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: