Provider Demographics
NPI:1366616377
Name:KRAUSE, PAULA D (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:D
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:FRAASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:559 VINCENT ST
Mailing Address - Street 2:ATTN: 21 MDOS/SGOHF - FAP
Mailing Address - City:PETERSON AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80914-1540
Mailing Address - Country:US
Mailing Address - Phone:719-556-8943
Mailing Address - Fax:866-867-7926
Practice Address - Street 1:115 S PARKSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910
Practice Address - Country:US
Practice Address - Phone:719-572-6340
Practice Address - Fax:719-447-4792
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO300301Medicare PIN