Doctor Name: | RICKI GENE KRUEGER |
NPI Number: | 1912268715 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA, LPC, LADC |
License Number: | 01202 |
Business Practice Address: | 3675 Ihduhapi Rd Loretto, MN - 553572120 |
Business Phone Number: | 7634794506 |
Business Fax Number: | 7634794372 |
Mailing Address: | 3675 Ihduhapi Rd, LORETTO |
State: | MN |
Postal Code: | 553572120 |
Phone Number: | 7634794506 |
Fax Number: | 7634794372 |
NPI Enumeration Date: | 06/07/2012 |
NPI Last Update Date: | 06/07/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 01202 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |