Provider Demographics
NPI:1366997710
Name:CRAUGH, JENNIFER NICOLE (MT-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NICOLE
Last Name:CRAUGH
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 MILL ST N
Mailing Address - Street 2:SUITE #2
Mailing Address - City:WEST SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:54669-2213
Mailing Address - Country:US
Mailing Address - Phone:608-799-4860
Mailing Address - Fax:414-377-3353
Practice Address - Street 1:1537 HERITAGE BLVD
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:WI
Practice Address - Zip Code:54669-9404
Practice Address - Country:US
Practice Address - Phone:608-799-4860
Practice Address - Fax:414-377-3353
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist