Provider Demographics
NPI:1275769077
Name:KRUEGER, ANDREW DAVID (PSYD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:DAVID
Last Name:KRUEGER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6605 N 19TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-1628
Mailing Address - Country:US
Mailing Address - Phone:888-958-5736
Mailing Address - Fax:888-958-5737
Practice Address - Street 1:6605 N 19TH AVE STE B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015
Practice Address - Country:US
Practice Address - Phone:888-958-5736
Practice Address - Fax:888-958-5737
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-004915103T00000X
MNLP5181103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist