| Doctor Name: | HALLIE KRAKLOW |
| NPI Number: | 1063803096 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | SAC-IT |
| License Number: | 17234-130 |
| Business Practice Address: | 8630 S Liberty Ln #2305 Oak Creek, WI - 531542991 |
| Business Phone Number: | 7155635272 |
| Business Fax Number: | |
| Mailing Address: | 8630 S Liberty Ln, #2305 OAK CREEK |
| State: | WI |
| Postal Code: | 531542991 |
| Phone Number: | 7155635272 |
| Fax Number: | |
| NPI Enumeration Date: | 02/12/2015 |
| NPI Last Update Date: | 02/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 17234-130 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |