Healthcare Provider Details

I. General information

NPI: 1295344034
Provider Name (Legal Business Name): STEFFANY KROEGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 3RD AVE NW
WAVERLY IA
50677-2010
US

IV. Provider business mailing address

2550 W UNION HILLS DR STE 350
PHOENIX AZ
85027-5187
US

V. Phone/Fax

Practice location:
  • Phone: 319-596-5910
  • Fax:
Mailing address:
  • Phone: 480-525-7091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number23121
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number100440
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: