Provider Demographics
NPI:1043659709
Name:KRUEGER, KATIE ROSE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ROSE
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:ROSE
Other - Last Name:KREBSBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1906 E BROADWAY AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4740
Mailing Address - Country:US
Mailing Address - Phone:701-404-0997
Mailing Address - Fax:701-566-8876
Practice Address - Street 1:1906 E BROADWAY AVE STE 2
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4740
Practice Address - Country:US
Practice Address - Phone:701-404-0997
Practice Address - Fax:701-566-8876
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5865104100000X
1041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker