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General NPI Number Information
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NPI Number | 1841692811
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Entity Type | Individual
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Provider Name | LEA KRUEGER CADCII, QMHP
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Gender | Female
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Dates
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Enumeration Date | 09/22/2014
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 4422 NE DEVILS LAKE BLVD
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City | LINCOLN CITY
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State | OR
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Zip | 97367-5000
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Country | US
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Telephone | 541-265-4947
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Fax | 541-994-0261
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Provider Business Mailing Address
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Address Line | 36 SW NYE ST
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City | NEWPORT
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State | OR
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Zip | 97365-3821
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Country | US
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Telephone | 541-265-4179
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Fax | 541-265-4194
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 17-02-19
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License Number State | OR
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