Provider Demographics
NPI:1427105295
Name:KROHN, ANGELA (LAT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:KROHN
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W291N9536 BADGER TRL
Mailing Address - Street 2:
Mailing Address - City:COLGATE
Mailing Address - State:WI
Mailing Address - Zip Code:53017-9613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:W291N9536 BADGER TRL
Practice Address - Street 2:
Practice Address - City:COLGATE
Practice Address - State:WI
Practice Address - Zip Code:53017-9613
Practice Address - Country:US
Practice Address - Phone:414-460-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI178-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer