Healthcare Provider Details

I. General information

NPI: 1841692811
Provider Name (Legal Business Name): LEA KRUEGER CADCII, QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 NE DEVILS LAKE BLVD
LINCOLN CITY OR
97367-5000
US

IV. Provider business mailing address

36 SW NYE ST
NEWPORT OR
97365-3821
US

V. Phone/Fax

Practice location:
  • Phone: 541-265-4947
  • Fax: 541-994-0261
Mailing address:
  • Phone: 541-265-4179
  • Fax: 541-265-4194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17-02-19
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: