Provider Demographics
NPI:1104046879
Name:KRAINEN, GORDON (PHD, CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:
Last Name:KRAINEN
Suffix:
Gender:M
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6235 MISSION DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-1396
Mailing Address - Country:US
Mailing Address - Phone:248-366-1999
Mailing Address - Fax:
Practice Address - Street 1:1111 CATHERINE ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-2054
Practice Address - Country:US
Practice Address - Phone:734-764-8440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist