Provider Demographics
NPI:1588294326
Name:KRAUTHOEFER, ANDREW
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:KRAUTHOEFER
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 1:19769 ASTRO PL
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2999
Mailing Address - Country:US
Mailing Address - Phone:262-853-4151
Mailing Address - Fax:
Practice Address - Street 1:780 NW YORK DR STE 204
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-1055
Practice Address - Country:US
Practice Address - Phone:458-202-9207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR5673101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor