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NPI Code Detail

MEDICARE: SUSAN J RAIR KRUG MSW,LICSW

MEDICARE: SUSAN J RAIR KRUG MSW,LICSW
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
11041C0700XClinical Social WorkerSW20580FL
2101YA0400XAddiction (Substance Use Disorder) Counselor101030OH
31041C0700XClinical Social Worker2243NH
41041C0700XClinical Social WorkerS0032078OH

General Provider Information

NPI Number : 1487888947
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN J RAIR KRUG MSW,LICSW
Provider Business Mailing Address
First Line : 246 NORTHLAND DR STE 200
Second Line :
City : MEDINA
State : OH
Zip : 44256-3440
Country : US
Telephone Number : 330-725-9195
Fax Number :
Provider Business Practice Location Address
First Line : 246 NORTHLAND DR STE 200
Second Line :
City : MEDINA
State : OH
Zip : 44256-3440
Country : US
Telephone Number : 419-543-3737
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2009
Last Update Date : 07/17/2023

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