Provider Demographics
NPI:1114588761
Name:KRUGER, ROXANNE LYNNE (MA, LLPC)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:LYNNE
Last Name:KRUGER
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 FULTON ST E # 2
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5923
Mailing Address - Country:US
Mailing Address - Phone:517-769-4444
Mailing Address - Fax:
Practice Address - Street 1:800 MONROE AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1445
Practice Address - Country:US
Practice Address - Phone:517-769-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017416101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor