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General NPI Number Information
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NPI Number | 1871785188
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Entity Type | Individual
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Provider Name | CASEY ELIZABETH KRUEGER PHD
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Gender | Female
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 04/08/2024
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Provider Practice Location Address
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Address Line | 725 WELCH RD
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City | PALO ALTO
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State | CA
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Zip | 94304-1601
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Country | US
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Telephone | 650-497-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 38 LILAC LN
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City | SOUTH SAN FRANCISCO
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State | CA
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Zip | 94080-2655
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Country | US
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Telephone | 925-324-3867
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PSY23055
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 34712
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY23055
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License Number State | CA
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