Provider Demographics
NPI:1407670391
Name:KRAUSE, LAURA A (EDS)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:A
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 CALIFORNIA RD
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-1220
Mailing Address - Country:US
Mailing Address - Phone:574-262-5861
Mailing Address - Fax:
Practice Address - Street 1:58840 RIVER FOREST DR
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46528-8306
Practice Address - Country:US
Practice Address - Phone:574-226-3401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1406429103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool