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NPI Code Detail

MEDICARE: LISA M. KRUEGER LPC, CRC

MEDICARE: LISA M. KRUEGER LPC, CRC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225C00000XRehabilitation Counselor00090636OH
2101YP2500XProfessional CounselorC0501305OH
3101YP2500XProfessional Counselor4392-125WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457541716
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA M. KRUEGER LPC, CRC
Provider Business Mailing Address
First Line : 1592 GRANVILLE PIKE
Second Line :
City : LANCASTER
State : OH
Zip : 43130-1076
Country : US
Telephone Number : 740-687-0835
Fax Number : 740-687-9391
Provider Business Practice Location Address
First Line : 3150 GERSHWIN DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-4328
Country : US
Telephone Number : 920-391-4740
Fax Number : 920-391-4731
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2007
Last Update Date : 07/07/2022

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