Provider Demographics
NPI:1194331298
Name:KRAJNIKCONDE, ADAM DAVID
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:DAVID
Last Name:KRAJNIKCONDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241B MENOMONIE ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-5974
Mailing Address - Country:US
Mailing Address - Phone:715-210-5023
Mailing Address - Fax:
Practice Address - Street 1:1241B MENOMONIE ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-5974
Practice Address - Country:US
Practice Address - Phone:715-210-5023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11239225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist