Healthcare Provider Details

I. General information

NPI: 1730012782
Provider Name (Legal Business Name): ELLEN FRANCES KRUEGER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-8710
  • Fax: 414-805-1101
Mailing address:
  • Phone: 414-805-8710
  • Fax: 414-805-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5566-057
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number5566-057
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: