Provider Demographics
NPI:1033344270
Name:KRUEGER, SHANNA LEE (LPC)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:LEE
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 GRANBAKKEN WAY
Mailing Address - Street 2:
Mailing Address - City:BOYCEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54725-9401
Mailing Address - Country:US
Mailing Address - Phone:715-702-2226
Mailing Address - Fax:
Practice Address - Street 1:715 STATE ROAD 79 STE B
Practice Address - Street 2:
Practice Address - City:BOYCEVILLE
Practice Address - State:WI
Practice Address - Zip Code:54725-7535
Practice Address - Country:US
Practice Address - Phone:715-643-2445
Practice Address - Fax:715-643-2391
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2019-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4191-125101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional