Provider Demographics
NPI:1447315601
Name:KRANICK, SARAH MATTESON (MD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MATTESON
Last Name:KRANICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:KATHLEEN
Other - Last Name:MATTESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:915 6TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4682
Mailing Address - Country:US
Mailing Address - Phone:253-403-7299
Mailing Address - Fax:
Practice Address - Street 1:915 6TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4682
Practice Address - Country:US
Practice Address - Phone:253-403-7299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD686392084N0400X
PAMD4386382084N0400X
WAMD604499452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024156420002Medicaid