Healthcare Provider Details

I. General information

NPI: 1275769077
Provider Name (Legal Business Name): ANDREW DAVID KRUEGER PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6605 N 19TH AVE STE B
PHOENIX AZ
85015
US

IV. Provider business mailing address

6605 N 19TH AVE STE B
PHOENIX AZ
85015-1628
US

V. Phone/Fax

Practice location:
  • Phone: 888-958-5736
  • Fax: 888-958-5737
Mailing address:
  • Phone: 888-958-5736
  • Fax: 888-958-5737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY-004915
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP5181
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: