Provider Demographics
NPI:1316496169
Name:KRAUS, JENNIFER PORTER
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:PORTER
Last Name:KRAUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7667 BERKSHIRE PKWY
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-1000
Mailing Address - Country:US
Mailing Address - Phone:315-289-5559
Mailing Address - Fax:
Practice Address - Street 1:7667 BERKSHIRE PKWY
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-1000
Practice Address - Country:US
Practice Address - Phone:315-289-5559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency