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General NPI Number Information
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NPI Number | 1790137917
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Entity Type | Individual
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Provider Name | JENNA KRUSE LMFT
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Gender | Female
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Dates
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Enumeration Date | 07/12/2016
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Last Update Date | 11/09/2022
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Provider Practice Location Address
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Address Line | 3910 S OLD HIGHWAY 94 STE 103
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City | SAINT CHARLES
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State | MO
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Zip | 63304-2834
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Country | US
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Telephone | 636-283-0088
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Fax | 636-284-2456
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Provider Business Mailing Address
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Address Line | 3910 S OLD HIGHWAY 94 STE 103
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City | SAINT CHARLES
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State | MO
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Zip | 63304-2834
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Country | US
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Telephone | 636-283-0088
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Fax | 636-284-2456
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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 | 2015019584
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License Number State | MO
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