Healthcare Provider Details

I. General information

NPI: 1083879365
Provider Name (Legal Business Name): HEATHER KRUG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 BOHMANN DR
RICHLAND CENTER WI
53581-2909
US

IV. Provider business mailing address

PO BOX 649
RICHLAND CENTER WI
53581-0649
US

V. Phone/Fax

Practice location:
  • Phone: 608-649-4483
  • Fax:
Mailing address:
  • Phone: 608-647-6106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3079-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: