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General NPI Number Information
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NPI Number | 1508359928
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Entity Type | Individual
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Provider Name | ERICK LICHTE KRUEGER
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Gender | Male
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 06/11/2018
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Provider Practice Location Address
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Address Line | 840 US-12 #1
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City | BARABOO
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State | WI
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Zip | 53913
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Country | US
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Telephone | 608-477-9858
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Fax |
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Provider Business Mailing Address
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Address Line | 840 US-12 #1
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City | BARABOO
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State | WI
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Zip | 53913
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Country | US
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Telephone | 608-477-9858
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2-125
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 3613-123
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License Number State | WI
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