Healthcare Provider Details

I. General information

NPI: 1609117316
Provider Name (Legal Business Name): JESSICA A KRUEGER MS, LPC, CSAC, CS-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA A BIBA

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 BROADWAY ST
BARABOO WI
53913-2183
US

IV. Provider business mailing address

PO BOX 29
BARABOO WI
53913-0029
US

V. Phone/Fax

Practice location:
  • Phone: 608-355-4200
  • Fax: 608-355-4299
Mailing address:
  • Phone: 608-355-4200
  • Fax: 608-355-4299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16090-132
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5661-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: