Basic Information
| Provider Information | |||||||||
| NPI: | 1740684596 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRAUSE | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | DUNN | ||||||||
| OtherFirstName: | AMY | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 25117 SW PARKWAY AVE | ||||||||
| Address2: | STE D | ||||||||
| City: | WILSONVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970709697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712242040 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17400 HOLY NAMES DR | ||||||||
| Address2: | |||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970345187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036752004 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2014 | ||||||||
| LastUpdateDate: | 06/05/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.