Provider Demographics
NPI:1043052012
Name:KRAUSE, AMBERLY ROSE (LSW, CADC)
Entity type:Individual
Prefix:
First Name:AMBERLY
Middle Name:ROSE
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:LSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 PRENTISS DR APT 205
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-2218
Mailing Address - Country:US
Mailing Address - Phone:630-551-5005
Mailing Address - Fax:
Practice Address - Street 1:3077 W JEFFERSON ST STE 104
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5263
Practice Address - Country:US
Practice Address - Phone:815-998-9663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.112461104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker