Provider Demographics
NPI:1982319547
Name:LANDGRAF, EMALEA
Entity type:Individual
Prefix:
First Name:EMALEA
Middle Name:
Last Name:LANDGRAF
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:PO BOX 5384
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-5384
Mailing Address - Country:US
Mailing Address - Phone:906-869-6747
Mailing Address - Fax:
Practice Address - Street 1:47 CHRISTIAN CT
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:CO
Practice Address - Zip Code:81631-5609
Practice Address - Country:US
Practice Address - Phone:906-869-6747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor