Provider Demographics
NPI:1164598611
Name:KREUTZER, DAVID DEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:DEAN
Last Name:KREUTZER
Suffix:
Gender:M
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:PO BOX 5855
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-5855
Mailing Address - Country:US
Mailing Address - Phone:308-384-7119
Mailing Address - Fax:308-384-0778
Practice Address - Street 1:2121 N WEBB RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1751
Practice Address - Country:US
Practice Address - Phone:308-384-7119
Practice Address - Fax:308-384-0778
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2124 AND 9761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025269-00Medicaid
NE279509Medicare ID - Type UnspecifiedDAVID D KREUTZER