Healthcare Provider Details

I. General information

NPI: 1073666285
Provider Name (Legal Business Name): RONALD JOSEPH KRUEGER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3506 N US HIGHWAY 51
JANESVILLE WI
53545-0726
US

IV. Provider business mailing address

3506 N US HIGHWAY 51
JANESVILLE WI
53545-0726
US

V. Phone/Fax

Practice location:
  • Phone: 608-756-2043
  • Fax: 608-757-5231
Mailing address:
  • Phone: 608-756-2043
  • Fax: 608-757-5231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2069-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: