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General NPI Number Information
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NPI Number | 1326355538
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Entity Type | Individual
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Provider Name | KATHY KRUEGER M.A., M.F.T.
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Gender | Female
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Dates
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Enumeration Date | 09/09/2010
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 902 CENTRAL AVE SUITE 308
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City | TRACY
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State | CA
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Zip | 95376-3929
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Country | US
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Telephone | 408-241-0373
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Fax | 209-830-0998
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Provider Business Mailing Address
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Address Line | PO BOX 834
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City | TRACY
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State | CA
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Zip | 95378-0834
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Country | US
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Telephone | 408-241-0373
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Fax | 209-830-0993
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 47823
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License Number State | CA
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