MEDICARE: TARA D. KRUEGER MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2008037177	MO
2	1041C0700X	Clinical Social Worker	149.012584	IL

General Provider Information

NPI Number	:	1154547453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA D. KRUEGER MSW, LCSW

Provider Business Mailing Address
First Line	:	1507 CURTIS CREEK RD
Second Line	:
City	:	QUINCY
State	:	IL
Zip	:	62301-6329
Country	:	US
Telephone Number	:	217-577-2097
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 E LAKE CTR STE 100
Second Line	:
City	:	QUINCY
State	:	IL
Zip	:	62305-5839
Country	:	US
Telephone Number	:	217-577-2097
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	03/30/2026

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