Provider Demographics
NPI:1164539185
Name:KREUGER, JANICE R (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:R
Last Name:KREUGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 EMERALD TER
Mailing Address - Street 2:ST 4
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2312
Mailing Address - Country:US
Mailing Address - Phone:618-233-0500
Mailing Address - Fax:618-233-7935
Practice Address - Street 1:6 EMERALD TER
Practice Address - Street 2:STE 4
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2312
Practice Address - Country:US
Practice Address - Phone:618-233-0500
Practice Address - Fax:618-233-7935
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0010161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL450250Medicare ID - Type Unspecified