Provider Demographics
NPI:1083906580
Name:KRUEGER, REBECCA M (APSW CSAC)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:M
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:APSW CSAC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:PASTERSKI KRUEGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:ONEIDA BEHAVIORAL HEALTH
Mailing Address - City:ONEIDA
Mailing Address - State:WI
Mailing Address - Zip Code:54155-0365
Mailing Address - Country:US
Mailing Address - Phone:920-490-3790
Mailing Address - Fax:
Practice Address - Street 1:2640 W POINT RD
Practice Address - Street 2:ONEIDA BEHAVIORAL HEALTH
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304
Practice Address - Country:US
Practice Address - Phone:920-490-3790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15501-132101YA0400X
WI8883-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)