MEDICARE: DR. STUART KRAUSE PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	372	WY
2	103TC0700X	Clinical Psychologist	511	SD

General Provider Information

NPI Number	:	1639232325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STUART KRAUSE PHD

Provider Business Mailing Address
First Line	:	643 NORTHERN LIGHTS BLVD
Second Line	:	APT 1311
City	:	BOX ELDER
State	:	SD
Zip	:	57719-6109
Country	:	US
Telephone Number	:	605-791-0666
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 N 5TH ST
Second Line	:	STE 321
City	:	RAPID CITY
State	:	SD
Zip	:	57701-1375
Country	:	US
Telephone Number	:	605-791-0666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	09/03/2013

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Directions to “ DR. STUART KRAUSE PHD” Practice Location

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