Doctor Name: | DR. NICOLE R. KRUGER |
NPI Number: | 1154428076 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY.D. |
License Number: | 2010042353 |
Business Practice Address: | 249 Clarkson Rd Suite 102 Ellisville, MO - 630112219 |
Business Phone Number: | 5155570560 |
Business Fax Number: | |
Mailing Address: | 249 Clarkson Rd, Suite 102 ELLISVILLE |
State: | MO |
Postal Code: | 630112219 |
Phone Number: | 5155570560 |
Fax Number: | |
NPI Enumeration Date: | 09/20/2006 |
NPI Last Update Date: | 03/23/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 2010042353 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |