Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | 00383038 |
NPI | 1013530542 |
---|---|
Provider Name | Mackaulie Krantz |
First Address | Maplewood, MN 55109-1984 |
Second Address | Maplewood, MN 55109-1984 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2020 |
Last Update Date | 19/05/2020 |