Provider Demographics
NPI:1891585436
Name:KRAKAUER, JENNA
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:KRAKAUER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 ADAMS MILL RD NW UNIT 209
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2152
Mailing Address - Country:US
Mailing Address - Phone:262-825-6922
Mailing Address - Fax:
Practice Address - Street 1:11150 FAIRFAX BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5066
Practice Address - Country:US
Practice Address - Phone:703-537-0373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA14359280235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist