Provider Demographics
NPI:1033431010
Name:KRUGER, JEAN LESLIE (M A , LMHC)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:LESLIE
Last Name:KRUGER
Suffix:
Gender:F
Credentials:M A , LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 E 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-9017
Mailing Address - Country:US
Mailing Address - Phone:360-457-4570
Mailing Address - Fax:
Practice Address - Street 1:3080 LOWER ELWHA ROAD
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98363
Practice Address - Country:US
Practice Address - Phone:360-452-8471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMH30002352101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health