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General NPI Number Information
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NPI Number | 1013530542
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Entity Type | Individual
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Provider Name | MACKAULIE KRANTZ MS, CRC
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Gender | Female
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Dates
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Enumeration Date | 05/19/2020
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Last Update Date | 05/19/2020
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Provider Practice Location Address
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Address Line | 2495 MAPLEWOOD DR
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City | MAPLEWOOD
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State | MN
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Zip | 55109-1984
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Country | US
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Telephone | 651-760-3109
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Fax | 651-967-9417
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Provider Business Mailing Address
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Address Line | 2495 MAPLEWOOD DR
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City | MAPLEWOOD
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State | MN
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Zip | 55109-1984
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Country | US
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Telephone | 651-760-3109
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Fax | 651-967-9417
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number | 00383038
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License Number State |
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