Provider Demographics
NPI:1023020849
Name:KRUEGER, AMY LAURELL (MS-CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LAURELL
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:MS-CCC-SLP
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:LAURELL
Other - Last Name:DELAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS-CCC-SLP
Mailing Address - Street 1:2508 COOPER AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-4471
Mailing Address - Country:US
Mailing Address - Phone:920-889-5095
Mailing Address - Fax:
Practice Address - Street 1:2508 COOPER AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-4471
Practice Address - Country:US
Practice Address - Phone:920-889-5095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2414-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42587200Medicaid