MEDICARE: MISS LISA ERIN KRUGER MS

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1245465194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LISA ERIN KRUGER MS

Provider Business Mailing Address
First Line	:	2915 S WENTWORTH AVE
Second Line	:	A
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-2511
Country	:	US
Telephone Number	:	414-520-3464
Fax Number	:	414-615-0627

Provider Business Practice Location Address
First Line	:	2915 S WENTWORTH AVE
Second Line	:	A
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-2511
Country	:	US
Telephone Number	:	414-520-3464
Fax Number	:	414-615-0627

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

Provider Enumeration Date	:	05/21/2009
Last Update Date	:	05/21/2009

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