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NPI Code Detail

MEDICARE: JACLYN KROEGER LCSW

MEDICARE: JACLYN KROEGER 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
11041C0700XClinical Social Worker149.015131IL

General Provider Information

NPI Number : 1548687817
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACLYN KROEGER LCSW
Provider Business Mailing Address
First Line : 11615 LORI LN
Second Line :
City : HUNTLEY
State : IL
Zip : 60142-7385
Country : US
Telephone Number : 815-353-9903
Fax Number :
Provider Business Practice Location Address
First Line : 2028 N SEMINARY AVE
Second Line :
City : WOODSTOCK
State : IL
Zip : 60098-2626
Country : US
Telephone Number : 815-338-3590
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2014
Last Update Date : 04/30/2014

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Directions to “ JACLYN KROEGER LCSW” Practice Location

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